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

Posted by:  :  Category: Medicare

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

Medicare Part C Advantage

A program which allows you to enroll in private health insurance that offers both Medicare Part A and Part B benefits. Medicare Advantage plans are not supplemental insurance, but rather health insurance plans of their own. Medicare Advantage can also include prescription drug coverage in addition to vision, hearing, and dental. In most cases, you can join even if you have been diagnosed with a pre-existing condition, except for final stage renal disease. Advantage plans must follow guidelines established by Medicare but also vary in terms of costs and rules.
Source: medicaresolutions.com

Medicare Part A, Part B, Part C, Part D, Ohio, Medicare Supplement Quote

Offers health plan options run by Medicare-approved private insurance companies. Medicare Advantage Plans are a way to get the benefits and services covered under Part A and Part B. Most Medicare Advantage Plans cover Medicare prescription drug coverage (Part D). Some Medicare Advantage Plans may include extra benefits for an extra cost.
Source: medicareohiohelp.com

Ways to pay Part A & Part B premiums

Posted by:  :  Category: Medicare

If your premium is late, you’ll get a Second Notice reminding you to pay your premium. If you don’t pay the premium by the due date for the Second Notice, you’ll get a Delinquent Notice. If you get a Delinquent Notice and you don’t pay your premium by the 25th of the month, you’ll lose your Medicare coverage.
Source: medicare.gov

Medicare Part B and Part D Premiums for 2014

The Centers for Medicare and Medicaid Services also announced that the Medicare Part A deductible, which people pay when admitted to the hospital, will increase by $32 in 2014, to $1,216. That deductible covers up to 60 days of Medicare-covered inpatient hospital care. Beneficiaries will pay $304 per day for days 61 through 90 in 2014 (up from $296 in 2013) and $608 per day for hospital stays beyond 90 days (up from $592 in 2013). The daily coinsurance rate for days 21 through 100 in a skilled-nursing facility rises from $148 to $152.
Source: kiplinger.com

Medicare Part B Premium Schedule

Make sure you enroll in Medicare just before reaching age 65, even if you are covered by another health plan. If you are already collecting Social Security or Railroad Retirement benefits, Medicare Part B premiums will be deducted from your monthly benefits. If you are not collecting Social Security or Railroad Retirement, you can pay premiums through an automatic deduction from your bank, by credit card or by mail. More »
Source: about.com

Medicare Part B outpatient medical insurance

Medicare Part B provides patients with medically necessary outpatient health care. Part B fills in some of Part A’s gaps by providing coverage for doctors in an outpatient setting as well as for approved medical equipment and supplies when necessary. Physician services, nursing services, vaccinations, cardiovascular and diabetes screenings, lab services, and other preventative services can all be covered by Part B. Routine physical exams are not covered by Part B.Medicare Part B will not pay for cosmetic surgery, custodial care, prescription drugs, dental care, or vision care, as well as other services.
Source: medicaresolutions.com

Medicare Supplemental, Advantage, and Part D Plans

Posted by:  :  Category: Medicare

Because of the significant amount of out-of-pocket payments required by traditional Medicare, a booming market of private-sector insurance products has grown up around the government programs. These Medicare-related insurance products are one of the fastest-growing segments of the U.S. health insurance industry overall. And they are the part of the market on which a smart consumer should focus his or her attention. Medicare Providers mission is to help seniors understand these products and provide tools assist in the decision making process.
Source: medicare-providers.net

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 Unmasked: Behind the Numbers

This list, based on data made public by the Centers for Medicare and Medicaid Services, shows the dollar amounts that doctors and other medical providers received in Medicare reimbursements in 2012, along with other data including their specialties. Only procedures which providers performed on more than 10 Medicare patients were included in the data released. There is some information CMS hasn’t provided. In some cases, procedures attributed to a specific physician may have been performed by other people under that doctor’s supervision. The data doesn’t include information on patients nor does it show doctors’ billings related to durable medical equipment.
Source: wsj.com

Medicare.gov Nursing Home Compare

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 Hospital Compare Quality of Care

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Source: medicare.gov

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

More Medicare Information

If you live in Puerto Rico you will not receive Medicare Medical Insurance (Medicare Part B) automatically. You will need to sign up for it during your initial enrollment period or you will pay a penalty. To sign up, please call our toll-free number at 1-800-772-1213 (TTY 1-800-325-0778). You also may contact your local Social Security office. You can find your local Social Security office by using our Office Locator.
Source: ssa.gov

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

Visiting Nurse Service of New York

Posted by:  :  Category: Medicare

Since the devastation of Sandy, VNSNY’s Emergency Response team is coordinating the efforts of thousands of professional and paraprofessional clinicians and office staff who continue to work around the clock to ensure that care is delivered seamlessly. Please donate online now to help us give New Yorkers the care they deserve, call 212-609-1525 to make a contribution over the phone, or print our donation form and mail it directly to us. We have established the VNSNY Relief Fund to help the many patients and employees affected by the aftermath of Sandy.
Source: vnsny.org

EmblemHealth: Family & Individual Health Insurance Plans In New York

To view this Web site, you need to have JavaScript enabled in your browser. Don’t worry — you can still sign in to the secure myEmblemHealth Web site or search for a doctor using the links below. If you need help registering for the secure site, please call Customer Service at the number on the back of your ID card.
Source: emblemhealth.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

SSA New York Region Home Page

For almost 80 years, the Social Security Administration has served the American people, providing the major source of income for most of our seniors. Social Security, however, is more than just retirement benefits. Social Security pays benefits to disabled workers and their dependents as well as the families of deceased workers. We administer the Supplemental Security Income program, a program based on need for people age 65 or older and people with disabilities, regardless of age. We also help Medicare beneficiaries with limited income and resources apply for extra help with the cost of their prescription drugs under the new Medicare Prescription Drug Program.
Source: socialsecurity.gov

Port Authority of New York and New Jersey

Dedicated toll lanes for one of the Fort Lee entrances (used by local traffic from Fort Lee and surrounding communities) to the upper level on the George Washington Bridge, which connects to Manhattan, New York, were reduced from three to one from September 9–13, 2013. The toll lane closures caused massive Fort Lee traffic back-ups, which affected public safety due to extensive delays by police and emergency service providers and disrupted schools due to the delayed arrivals of students and teachers. Two Port Authority officials (who were appointed by Christie and would later resign) claimed that reallocating two of the toll lanes from the local Fort Lee entrance to the major highways was due to a traffic study evaluating “traffic safety patterns” at the bridge, but the Executive Director of the Port Authority was unaware of a traffic study.
Source: wikipedia.org

Affordable health insurance plans for individuals, employers, brokers, providers

Being a HealthNow member means more than just great healthcare coverage. It also means access to wellness programs, discounts on fitness and health services, and your own personal healthcare consultant. A healthier life starts here.
Source: healthnowny.com

Sustainable Growth Rates & Conversion Factors

Posted by:  :  Category: Medicare

Section 1848 of the Social Security Act requires the Secretary to make available to the Medicare Payment Advisory Commission (MedPAC) and the public by March 1 of each year, an estimated Sustainable Growth Rate (SGR) and estimated conversion factor applicable to Medicare payments for physicians’ services for the following year and the data underlying these estimates. We provide the estimates and information applicable to physician fee schedule payments via this web page.
Source: cms.gov

Medicare reimbursement rates by state (medical, plan, hospital, doctor)

Your are asking a question that really has no clear answer and even if you had the answer, it would be meaningless to you. What you are asking for is called a Fee Schedule. There are Fee Schedules for Physicians, for different specialties, for procedure, for durable medical equipment, for ambulances, for clinical laboratory services etc. Also Fee Schedules are not based on a State but on smaller geographical areas within the State, using zip code identifiers. So a list of State information that gives some average calculated data from these specific areas will mean nothing. You can bet that fee schedules are much different for Buffalo than for New York City. You must understand that the fee schedule is based on complicated formulas for different aspects of care and geographic area of practice. You would have to understand GPCI, Geographic Practice Cost Index as related to the MPFS (Medicare Physician Fee Scheldule) if you are looking for Physician Fee Schedule. You would have to know the RVU (Relative Value Unit) for different procedures. In addition, all that would be just a part of the issue of acceptance or non-acceptance of original medicare patients. You cannot tell if the physician has the maximum patients that he can handle and what are the percentages he views as economical to his practice. You could not tell if the physician is practicing in an area with a large Medicare or Medicaid base of patients. You could not tell the amount of physicians per population and whether it can sustain a greater patient load. You cannot tell if the the practice is new and is building new patients or if the practice has more elderly patients that they lose to death and need more. If you want to be assured more of being accepted as a patient then add to your original medicare with a supplemental plan that will provide better reimbursement and will have physicians on their plan willing to accept you. In addition all this will change radically, when many more people are eligible for healthcare under the Affordable Care Act, so that a Physician may have more than enough customers, So, you think you have problems now. I will bet that Physicians will not want or even need more customers who do not want to buy more insurance to attach to basic medicare. If you say that is unfair, that is reality. For Americans are deemed to have enough money to buy more insurance if they are not consider poor. If they are poor, then they would qualify for Medicaid on top of Medicare. I am on Medicare and I have extra coverage and I have no problems finding a Physician. Sure it cost more every month; you just have to budget. That is the answer to your question, not hunting around the country for doctors and what will you do when new masses of patients come knocking on the doctor’s door, with a better plan and more money–you will be pushed aside. Livecontent
Source: city-data.com

Medicare Sustainable Growth Rate

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

How Medicare, Other Payers Determine Physician Reimbursement Rates

Do you know how Medicare and other payers determine reimbursement rates? Most physicians don’t. Reading this summary of the history and elements will take less than three minutes, and will make you better informed than most. History. The resource-based relative value scale (RBRVS) was introduced in the Omnibus Budget Reconciliation Act of 1989. The intent was to create a uniform and objective payment system to address the large payment disparities produced under the traditional usual, customary, and reasonable (UCR) standard. The new scheme was adopted over a five-year transition period.  NOTE: The sustainable growth rate (SGR) was part of the Balanced Budget Act of 1997 and is separate. Relative Value Units (RVUs) and CPT codes. Three RVUs are assigned to each CPT code: Physician work RVU: A relative measure of the time, skill, training, and intensity required to provide a specific service The goal is for each CPT code to be reviewed at least every five years in order to make adjustments to reflect changes in the components of the service. Practice expense RVU: Addresses expenses associated with providing the service. The direct costs (staff allocation, supplies, and equipment) of the service are calculated; indirect costs (any costs of operations not directly involved in providing the service) are allocated. A new method of calculating practice expense was fully implemented in 2010, after a transition period. Malpractice RVU: Costs associated with professional liability expenses. Who sets RVUs? CMS sets RVUs based upon the recommendations of the Specialty Society Relative Value Scale Update Committee (RUC). The RUC is made up of 29 physicians, 23 of whom are nominated by professional societies. Almost all are specialists. CMS is not bound to accept either the professional society nominees or the RUC’s recommendations, but it has historically approved more than 90 percent of RUC recommendations. The process has been criticized for a lack of transparency. There are also those who argue for more representation by primary-care providers, private insurers, and employee health plan purchasers. Geographic Practice Cost Indices (GPCI). A GPCI is calculated, by CMS, for each of the RVU components. The GPCIs are reviewed every three years and attempt to take into account the different costs associated with different areas of the country. Conversion Factor (CF). The CF translates RVUs and GPCIs into actual dollars. It is updated annually according to a formula specified by statute. CMS may not, by statute, increase its total annual budget by more than $20 million. If shifts in the RVUs would increase CMS’ budget by more than $20 million, the CF is used to achieve, essentially, budget neutrality. Congress may override the CF formula and regularly does. Non-Facility Payment Amount. A non-facility is a freestanding physician’s office, as well as other freestanding settings. Inpatient facilities, hospital outpatient clinic settings, and off-site hospital-owned locations are considered “facilities.” The payment for each CPT code in a non-facility is calculated as follows: Payment = [(Physician Work RVU X Work GPCI) + (Non-Facility Practice Expense RVU X Practice Expense GPCI) +     (Malpractice RVU X Malpractice GPCI)] X (Conversion Factor, adjusted for budget neutrality) 2014 Payment Changes. CMS released the finalized payment rates and policies for 2014 on Nov. 27, 2013. The total payments under the fee schedule are projected to be $87 billion. The largest increases go to psychiatry, clinical psychologists, and clinical social workers, as well as other providers of mental health services. There was also an aggregate increase in physician work RVUs and a corresponding decline in practice expense RVUs. Beginning in 2015, CMS will establish separate payments for managing a patient’s care outside of face-to-face contact. Private Payer Reimbursement. Most, if not all, private payers tie their reimbursement rates to Medicare’s. Contrary to widespread perception, private payers often reimburse at rates lower than Medicare. As intricate as this may seen, these are just the basics. Bonuses and penalties for quality, patient satisfaction, eRX, and meaningful use are topics for another day.
Source: physicianspractice.com

Medicare Fee Schedule, Payment and Reimbursement Benefit Guideline, CPT Code Billing: What are Medicare Reimbursement Rates?

Medicare reimbursement rates are the rates paid to doctors for performing a certain procedure. For example, those who go to the doctor for a regular checkup, and are on Medicare, will be covered by a certain amount under the policy. That is the payment the doctor can expect. While the system is relatively straightforward and simple, there is also some controversy associated with Medicare reimbursement rates. Some doctors feel that the rates fail to meet their expenses. All doctors have the opportunity to decide whether they want to participate in the Medicare program. Even doctors who do not officially list themselves as Medicare providers may be able to see patients and submit claims for them. If this happens, the Medicare reimbursement rates that doctor receives will be somewhat less than those a participating doctor receives. Therefore, doctors who decide to opt out of the system normally will not see Medicare patients at all. In the past, the Medicare reimbursement rate was dependent on a complex formula that included the cost of living in the local area. A doctor in a rural state with a lower cost of living and, it is assumed, lower expenditures, would not be paid the same amount as a doctor in a metropolitan area, even if the family practice was similar. That led to many rural doctors protesting the Medicare reimbursement rates, saying that no matter where they lived they still had significant expenses, including student loans, that were on par with their big city counterparts. Further, the U.S. government realized its policy was discouraging doctors from setting up practices in under-served areas. Thus, there is now a more uniform payment distribution of Medicare reimbursement rates. Other things may affect the rates as well. A hospital’s Medicare reimbursement rate will generally be higher than that of a doctor’s office. This is because the expenses of a hospital to perform the same procedure are generally greater than for a doctor in private practice with the same capability. Those health care providers who will accept Medicare patients have no choice, but to accept Medicare reimbursement rates for any procedure they offer. They cannot pick and choose. Further, they cannot charge the patient additional co-pays to make up for what a private insurance carrier might be willing to pay for the same procedure. While these may be considered disadvantages, the benefit for the doctor comes in having access to a greater number of patients. Many of these patients will require increasing numbers of visits to the doctor as they age, thus providing a steady stream of income for the doctor.
Source: medicarepaymentandreimbursement.com

Medicare Part B Reimbursement

The Centers for Medicare and Medicaid Services (CMS) announced the Medicare Part B premium will not increase in 2015; it will remain at the 2014 standard rate of $104.90 for most Medicare enrollees. Higher income Medicare enrollees who filed an individual (or married and filing separately) 2012 tax return showing a modified adjusted gross income greater than $85,000 (or $170,000 for a joint tax return) are responsible for a larger portion of the estimated total cost of Part B benefit coverage. Read more about Medicare Premium Amounts for Persons with Higher Income Levels.
Source: lacera.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

California Health Advocates: Medicare Policy, Advocacy and Education

Bonnie Burns, our Training and Policy Specialist, begins her 23rd term as one of the 20 appointed and funded consumer liaison representatives by the National Association of Insurance Commissioners (NAIC). Ms. Burns spearheaded the standardization of Medicare supplemental insurance, known as Medigap and has provided numerous Congressional testimonies guiding the standardization of long-term care insurance and the policies for financing long-term care.
Source: cahealthadvocates.org

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

Open Enrollment for 2015 Medicare Advantage, Supplement plans, and Dental plans

If you need assistance making changes to your benefits, if you do not receive a packet, or if you have questions, please call 277-6947 (MYHR), or stop by the HR Service Center for more information. The HR Service Center is open Monday through Friday, 8:00 am – 5:00 pm and is located at the corner of Lomas and University Blvd.                                                       
Source: unm.edu

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

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Source: medicare.gov

Dental Insurance, Individual Vision Plan, Senior, Medicare Supplement

MWG Insurance Mall is the premier health insurance site online. Here, you’ll find great support in your search for Medicare supplemental insurance, dental insurance, and many other types of coverage. We strive to make our site as accessible as possible. Find a solution for your health insurance needs by relying on us to find the perfect senior life insurance plan, vision plan, or dental coverage. If you require further guidance, reach out to us.
Source: mwginsurancemall.com