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

Medicare Plan Finder for Health, Prescription Drug and Medigap plans

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Source: medicare.gov

Affordable Medicare Plans

Medicare-Plans.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: medicare-plans.org

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

NEBRASKA MEDICAID PROGRAM

Posted by:  :  Category: Medicare

To apply for medical assistance, an application must be completed and given to the Nebraska Department of Health & Human Services. For more information, contact your nearest Department of Health and Human Services Office; Or, you may download an application form and mail it to the nearest Department of Health and Human Services Office.
Source: ne.gov

Nebraska DHHS: Division of Medicaid & Long Term Care

The State Unit on Aging collaborates with public and private service providers to ensure a comprehensive and coordinated community-based services system that will assist individuals to live in a setting they choose and continue to be contributing members of their community. Nebraska’s aging network includes eight Area Agencies on Aging.
Source: ne.gov

Compare Medicare Supplement (Medigap) Plans and Rates in Your Area

Posted by:  :  Category: Medicare

"Times have changed since my mother had an AARP J plan and I was totally confused by the options available. Stan walked me through the process in a very educational, methodical, friendly way, and I feel secure now that we’re making the correct decision to provide the best possible coverage for my husband." – Pat K.
Source: medigap360.com

Medigap (Medicare Supplement Health Insurance)

A Medigap policy is health insurance sold by private insurance companies to fill the “gaps” in Original Medicare Plan coverage. Medigap policies help pay some of the health care costs that the Original Medicare Plan doesn’t cover. If you are in the Original Medicare Plan and have a Medigap policy, then Medicare and your Medigap policy will each pay its share of covered health care costs. Generally, when you buy a Medigap policy you must have Medicare Part A and Part B. You will have to pay the monthly Medicare Part B premium ($96.40 in 2011 for most beneficiaries). In addition, you will have to pay a premium to the Medigap insurance company. As long as you pay your premium, your Medigap policy is guaranteed renewable. This means it is automatically renewed each year. Your coverage will continue year after year as long as you pay your premium. In some states, insurance companies may refuse to renew a Medigap policy bought before 1992. Insurance companies can only sell you a “standardized” Medigap policy. Medigap policies must follow Federal and state laws. These laws protect you. The front of a Medigap policy must clearly identify it as “Medicare Supplement Insurance.” It’s important to compare Medigap policies, because costs can vary. The standardized Medigap policies that insurance companies offer must provide the same benefits. Generally, the only difference between Medigap policies sold by different insurance companies is the cost. You and your spouse must buy separate Medigap policies.Your Medigap policy won’t cover any health care costs for your spouse. Some Medigap policies also cover other extra benefits that aren’t covered by Medicare. You are guaranteed the right to buy a Medigap policy under certain circumstances. For more information on Medigap policies, you may call 1-800-633-4227 and ask for a free copy of the publication “Choosing a Medigap Policy: A Guide to Health Insurance for People With Medicare.” You may also call your State Health Insurance Assistance Program (SHIP) and your State Insurance Department. Phone numbers for these Departments and Programs in each State can be found in that publication.
Source: cms.gov

Best Medicare Supplement Insurance Quotes

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

Should I Buy Supplemental Health Insurance?

Hospital Indemnity Insurance Hospital Indemnity Insurance (also known as Hospital Confinement Insurance) provides a cash benefit if you are “confined” to a hospital due to an illness or serious injury. The cash benefit – doled out in one lump sum or as daily or weekly payments – may not start until after a minimum waiting period. Similar to other types of supplemental insurance, the additional coverage is meant to help you pay for services and needed items not covered by your regular health plan.
Source: about.com

Learn About Supplemental & Life Insurance

Sounds great, right? But is it affordable? Supplemental insurance – especially considering the benefits are paid to you – is generally very affordable. In fact, some policies can be secured for under $10 a month, depending on the amount of coverage you choose. Consider the high cost of healthcare these days. Consider, too, lost wages if you’re sick or have an accident and can’t work. Supplemental insurance can help you with those costs, and more, making a difficult situation a little easier to bear. Now that you know more about supplemental insurance, the real question is – can you afford not to have it?
Source: combinedinsurance.com

DMEPOS Competitive Bidding

Posted by:  :  Category: Medicare

Under the program, a competition among suppliers who operate in a particular competitive bidding area is conducted. Suppliers are required to submit a bid for selected products. Not all products or items are subject to competitive bidding. Bids are submitted electronically through a web-based application process and required documents are mailed. Bids are evaluated based on the supplier’s eligibility, its financial stability and the bid price. Contracts are awarded to the Medicare suppliers who offer the best price and meet applicable quality and financial standards. Contract suppliers must agree to accept assignment on all claims for bid items and will be paid the bid price amount. The amount is derived from the median of all winning bids for an item.
Source: cms.gov

Competitive Bidding Program

The Competitive Bidding Program replaces the outdated prices Medicare has been paying with lower, more accurate prices. Under this program, suppliers submit bids to provide certain medical equipment and supplies at a lower price than what Medicare now pays for these items. Medicare uses these bids to set the amount it pays for those equipment and supplies under the Competitive Bidding Program. Qualified, accredited suppliers with winning bids are chosen as Medicare contract suppliers.
Source: medicare.gov

DME Competitive Bidding Program

The Competitive Bidding Program replaces the outdated prices Medicare has been paying with lower, more accurate prices. Under this program, suppliers submit bids to provide certain medical equipment and supplies at a lower price than what Medicare now pays for these items. Medicare uses these bids to set the amount it will pay for those equipment and supplies under the competitive bidding program. Qualified, accredited suppliers with winning bids are chosen as Medicare-contract suppliers.
Source: medicare.gov

Medicare Expands Competitive Bidding Program for Durable Medical Equipment

You can also get the supplies from a store or pharmacy that accepts "Medicare assignment." This means that the store will accept the Medicare-approved amount as payment in full and that you cannot be charged more than a 20 percent copay (after you meet your annual deductible). A Medicare contract supplier can’t charge you more than that for the equipment or supplies included in the competitive bidding program.
Source: aarp.org

Medicare National Competitive Bidding Program

CCS Medical is one of only 18 suppliers awarded CMS contracts to provide mail order diabetic testing supplies at competitively bid prices nationwide and in the four U.S. territories (American Samoa, Guam, Puerto Rico, and the U.S. Virgin Islands). As announced previously by CCS Medical, one of the brands that CCS Medical will be carrying is LifeScan’s OneTouch® Ultra® test strips, the No. 1 brand recommended by endocrinologists and diabetes educators.
Source: ccsmed.com

: DMEPOS Competitive Bidding : Health Industry Washington Watch

CMS has just released a proposed rule that would require Medicare prior authorization (PA) for certain Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) items that the agency characterizes as “frequently subject to unnecessary utilization.“ As part of the rulemaking, CMS has developed a “Master List” of initial items that it considers to meet this standard based on being (1) identified in a GAO or HHS OIG national report published in 2007 or later as having a high rate of fraud or unnecessary utilization; or (2) listed in the 2011 or later Comprehensive Error Rate Testing (CERT) program’s Annual Medicare FFS Improper Payment Rate Report DME Service Specific Overpayment Rate Appendix. CMS also proposes limiting the items on the Master List to those with an average purchase fee of at least $1,000 or an average rental fee schedule of at least $100 to allow CMS to focus on items with the largest potential savings for the Medicare Trust Fund. CMS proposes that the Master List will be “self-updating” annually, and that items generally will remain on the list for 10 years. Note, however, that presence on the Master List would not automatically require prior authorization. CMS would limit the PA requirement to a subset of items (called the “Required Prior Authorization List") “to balance minimizing provider and supplier burden with our need to protect the Trust Funds." CMS would publish the Required Prior Authorization List in the Federal Register with 60-day notice before implementation. CMS also proposes that the PA program could be implemented nationally or locally. The proposed rule does not announce the first items on the Required Prior Authorization List. Instead, CMS is seeking public comment on the number of items that should be selected initially and in the future, and the frequency with which CMS should select items.
Source: healthindustrywashingtonwatch.com

CMS announces DMEPOS competitive bidding timeline

The seven product categories included in the Round 2 recompete are: enteral nutrients and equipment; general home equipment; nebulizers; negative pressure wound therapy pumps; respiratory equipment; standard mobility equipment; and transcutaneous electrical nerve stimulation devices.
Source: hmenews.com

Cost Report Data provides hospital financial information from Medicare cost reports filed by hospitals and contained in the CMS HCRIS file

Posted by:  :  Category: Medicare

CostReportData.com provides online Medicare cost report data to healthcare financial and reimbursement professionals. Our database of more than 6,000 hospitals is built from Medicare cost report information obtained from the federal Centers for Medicare and Medicaid Services (CMS).
Source: costreportdata.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

Simione Consultants: The Medicare HHA Cost Report LETS GET IT RIGHT!

15. COST REPORT CERTIFICATION (WORKSHEETS) CERTIFICATION BY OFFICER OR ADMINISTRATOR OF PROVIDER(S) I HEREBY CERTIFY that I have read the above statement and that I have examined the accompanying electronically filed or manually submitted cost report and the Balance Sheet and Statement of Revenue and Expenses prepared by____________________________________________ (Provider Name(s)and Number(s)) for the cost reporting period beginning and ending and that to the best of my knowledge and belief, it is a true, correct and complete statement prepared from the books and records of the provider in accordance with applicable instructions, except as noted. I further certify that I am familiar with the laws and regulations regarding the provision of health care services and that the services identified in this cost report were provided in compliance with such laws and regulations. 15 Things to Consider: False Claims Act
Source: slideshare.net

Medicare Administrative Costs Are Higher, Not Lower, Than for Private Insurance

When administrative costs are compared on a per-person basis, the picture changes. In 2005, Medicare’s administrative costs were $509 per primary beneficiary, compared to private-sector administrative costs of $453. In the years from 2000 to 2005, Medicare’s administrative costs per beneficiary were consistently higher than that for private insurance, ranging from 5 to 48 percent higher, depending on the year (see Table 1). This is despite the fact that private-sector "administrative" costs include state health insurance premium taxes of up to 4 percent (averaging around 2 percent, depending on the state)–an expense from which Medicare is exempt–as well as the cost of non-claim health care expenses, such as disease management and on-call nurse consultation services.
Source: heritage.org

Why Medicare Advantage costs taxpayers billions more than it should

Since 2004, the government has paid Medicare Advantage plans using a complex tool called a risk score. The idea is to pay higher rates for sicker patients and less for those in good health. But over the past decade, officials have struggled to control sharp increases in risk scores that have cost taxpayers billions of dollars. The industry says higher scores result from sicker patients and more thorough documentation of their health. Critics dispute that and want the government to make public more billing records that would help determine if health plans are being paid too much. This graphic plots changes in risk scores at more than 5,700 health plans in 3,000 counties nationwide between 2007 and 2011.
Source: publicintegrity.org

Highmark Medicare Services is now Novitas Solutions

Posted by:  :  Category: Medicare

Physicians and medical billing companies should not face many disruptions as a result of this transition. According to Novitas Solutions, the current Highmark Medicare website will be fully transitioned to the new Novitas site by March 30, 2012. During the transition, visitors to the old website (https://www.highmarkmedicareservices.com) will be automatically re-directed to the new Novitas Solutions website (https://www.novitas-solutions.com), where a new header and page logo can be seen. Bookmarks that users may already have for the Highmark website will purportedly still work with the new page. The Electronic Payer ID has not appeared to change, so claims submission and processing should remain unaffected by the transition. For more information, see the Informational Alert here: https://www.novitas-solutions.com/partb/info-alerts.html.
Source: healthcarebiller.com

Highmark Medicare Services Inc Becomes Novitas Solutions Inc

Effective March 10, Novitas Solutions will begin to migrate the current HMS Web site to the new Novitas Solutions Web site, www.novitas-solutions.com. Novitas is targeting completing the name change to all active Web page content by March 30. Although main headers throughout the Web site will be changed, some historical documents, such as Medicare reports issued under HMS, will not be changed to reflect the new name.
Source: apta.org

Highmark: Your Health Care Partner

Highmark Inc. is a national, diversified health care partner serving members through its businesses in health insurance, dental insurance, vision care and reinsurance. Our mission is to make high-quality health care readily available, easily understandable and truly affordable in the communities we serve.
Source: highmark.com

Novitas Solutions, formerly called Highmark Medicare Services, announces hundreds of health care jobs coming to Harrisburg, Pittsburgh areas

The prospect of new jobs arises from a large, new contract that was in limbo at the time of the sale. The contract, which involves administering Medicare claims for seven Southwestern states, was expected to create 500 new jobs in Pennsylvania, with about 260 coming to the Harrisburg area.
Source: pennlive.com

​UPMC’s Medicare Advantage Provider Contracts with Highmark Will Not Be Extended for 2016

Nearly a year ago, however, Highmark stopped paying UPMC the rates specified in those contracts for that world-class care—including treatment for cancer at the renowned Hillman Cancer Center—and claimed that it has the right to reduce rates whenever and however it wishes. Although UPMC gave Highmark more than sufficient opportunity to take the required corrective actions, it has refused. As a result of Highmark’s breach of its UPMC contracts, and in keeping with UPMC’s right to end the contracts at the end of each calendar year with or without cause, UPMC has provided Highmark with notices of non-renewal of the current Medicare Advantage contracts effective January 1, 2016. No responsible organization could enter into—let alone extend—such illusory and one-sided contracts.
Source: upmc.com

Highmark, UPMC battle complicates Medicare open

Then, on Nov. 20, Highmark announced that it was severing its contracts with nearly 700 UPMC doctors. While Highmark says it has offered those same physicians Medicare-only reimbursement contracts, UPMC won’t let those doctors sign the revised contracts — meaning the doctors could be out-of-network for Highmark’s senior customers.
Source: post-gazette.com

America’s Health Insurance Plans

Posted by:  :  Category: Medicare

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

Travel Guard: Travel Insurance for Trip Cancellation, Medical/Health & Accident Coverage, Flight Delays, Hurricane and Tropical Storms from TravelGuard.com

Travel Guard is committed to providing products and services that will exceed expectations. If you are not completely satisfied, you can receive a refund of the cost, minus the service fee. Requests must be submitted to Travel Guard in writing within 15 days of the effective date of the coverage, provided it is not past the original departure date. Not applicable to residents of the state of New York.
Source: travelguard.com

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

What is a Medicare Advantage Plan

Posted by:  :  Category: Medicare

Medicare Advantage are private health plans that help with hospital costs, medical costs, and often prescription drug expenses. Once called “Medicare+Choice”, these plans became known as Medicare Advantage in 2003 due to the Medicare Prescription Drug, Improvement, and Modernization Act. Many plans offer additional benefits beyond traditional Medicare coverage. Premiums vary for Medicare Advantage plans and, in some areas, there are plans that offer Medicare Advantage benefits for no monthly premium (although all Medicare Advantage beneficiaries are still responsible to continue to pay their Medicare Part B premium).
Source: planprescriber.com

What Medicare health plans cover

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, Demonstration/Pilot Programs, and Programs of All-inclusive Care for the Elderly (PACE).
Source: medicare.gov

What is the Medicare Advantage maximum out pocket?

Ross Blair has applied more than 26 years of technology experience to develop PlanPrescriber.com, a website that makes it easier for seniors and their caregivers to select and enroll in the best Medicare products for their specific needs. In his role as CEO, he has worked closely with pharmacists, insurers, physicians, caregivers and seniors to identify the most critical and complex aspects of Medicare and create a system that delivers this information to consumers in a format that is easy to use and understand.
Source: ehealthinsurance.com

What is "deeming" under Medicare Advantage?

An enrollee walks into a physician’s office for the first time, advises the physician that he or she is a member of the PFFS plan and presents his or her plan enrollment card. Since the provider had the opportunity to call the plan phone number on the enrollee card, the provider is considered deemed contracting as soon as s/he provides services, even though the provider did not actually check the terms and conditions of payments.
Source: mgma.com

TEXAS MEDICAID APPLICATION

Posted by:  :  Category: Medicare

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

Texas Medicaid/CHIP Vendor Drug Program

Processes out-patient pharmacy prescription claims for Medicaid fee-for-service, the Texas Women’s Health Program, the DSHS Children with Special Health Care Needs (CSHCN) Services Program, and the DSHS Kidney Health Care (KHC) program.
Source: txvendordrug.com

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

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

America’s Health Insurance Plans

Posted by:  :  Category: Medicare

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

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

Physicians for a National Health Program

The Affordable Care Act will add more than a quarter of a trillion dollars to the already very high administrative costs of U.S. health care through 2022, according to a study published Wednesday at the Health Affairs Blog.
Source: pnhp.org

Health Care Accreditation, Health Plan Accreditation Organization

PCMH Congress, October 9-11, San Francisco PCMH Congress is NCQA’s official national conference for PCMH clinicians, experts, consultants and quality managers dedicated to transforming primary care practices into medical homes. Don’t miss your opportunity to hear from industry experts and your peers on the wide-ranging work that they are doing in the medical home field.
Source: ncqa.org