Coventry Medicare: Advantra Plans

Posted by:  :  Category: Medicare

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 (HMO/PPO)

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

Advantra Silver (HMO) 2014

The Federal Government pays health plans to provide your Medicare Advantage benefits. Sometimes plans require you to pay a premium in addition to the money they receive from the Government, and some do not. Those that do not are $0 premium plans.
Source: healthpocket.com

Medicare Advantage Plans By State, Plan Comparison

Coventry Health Care* is a Coordinated Care plan with a Medicare contract. Enrollment in our plans depends on contract renewal. Coventry Health Plan of Florida, Inc. also has a contract with the Florida state Medicaid program. Coventry Health Care of Missouri has contracts with the Missouri state Medicaid program. HealthAmerica also has a contract with the Pennsylvania state Medicaid program. The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan. Limitations, copayments, and restrictions may apply. Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next. Our dual-eligible Special Needs Plans (DSNPs) are available in Florida, Missouri and Pennsylvania to anyone who has both Medical Assistance from the state and Medicare. Premiums, copays, coinsurance and deductibles may vary based on the level of Extra Help that you receive. Please contact the plan for further details. Our dual-eligible Special Needs Plans (DSNPs) are available to anyone who has both Medical Assistance from the State and Medicare. You must continue to pay your Medicare Part B premium. The Part B premium is covered for full-dual members where DSNP plans are available. This information is available for free in other languages. Please call Coventry Health Care at 1-877-988-3589, 8 a.m. to 8 p.m., seven days, from October 1 – February 14; 8 a.m. to 8 p.m. Monday – Friday, from February 15 – September 30. Medicare beneficiaries may also enroll in Coventry plans through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov. *Coventry Medicare Advantage plans are offered by Coventry Health Care, Inc.’s licensed affiliated companies, which include Altius Health Plans, Inc.; Coventry Health Plan of Florida, Inc.; Coventry Health Care of Georgia, Inc.; Coventry Health Care of Illinois Inc.; Coventry Health Care of Iowa, Inc.; Coventry Health Care of Louisiana, Inc.; Coventry Health Care of Missouri, Inc.; Coventry Health Care of Nebraska, Inc.; Coventry Health and Life Insurance Company; Coventry Health Care of Kansas, Inc.; Coventry Health Care of Texas, Inc.; Coventry Health Care of West Virginia, Inc.; First Health Life & Health Insurance Company; HealthAmerica Pennsylvania, Inc.; and HealthAssurance Pennsylvania, Inc.
Source: coventryhealthcare.com

Coventry Medicare: Advantra (HMO/PPO)

Western Pennsylvania & Ohio Phone: 1-855-338-9566   Central Pennsylvania & Southeastern Pennsylvania Phone: 1-855-338-9566   TDD/TTY: 711 Telecommunications Relay Service or 1-800-877-8973 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
Source: coventryhealthcare.com

Chcadvantra.com: Coventry Medicare: Medicare Advantage Plans

chcadvantra, medicare, plans, advantage, coventry, size, adobe, reader, plan, banner, image, logo, section, text, contact, drug, coverage, prescription, care, health, page, enroll, gov, site, www, policy, explore, providers, benefits, click, information, privacy, home, http, terms, conditions, network, containing, link, letter,
Source: cqcounter.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

The United States Social Security Administration

A healthy life is a good life. The Medicare benefits you’ve earned ensure that you can receive the care you need, when you need it. And, when it comes to Medicare benefits, the most important thing to remember is…
Source: socialsecurity.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

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

2015 Medicare Advantage Plans Available to Residents of Illinois

Posted by:  :  Category: Medicare

AK  AL  AR  AZ  CA  CO  CT  DC  DE  FL  GA  HI  IA  ID  IL  IN  KS  KY  LA  MA  MD  ME  MI  MN  MO  MS  MT  NC  ND  NE  NH  NJ  NM  NV  NY  OH  OK  OR  PA  RI  SC  SD  TN  TX  UT  VA  VT  WA  WI  WV  WY
Source: q1medicare.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

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

Administrator and Biller of Illinois Physician Group Convicted in $4.5 Million Medicare Fraud Scheme

According to evidence presented at trial, Rick E. Brown, 58, of Rockford, Illinois, the President of Home Care America Inc., controlled the daily operations of a physician practice, Medicall Physicians Group Ltd.  Mary C. Talaga, 54, of Elmwood Park, Illinois, was the company’s biller who submitted Medicall’s Medicare claims and was employed by Home Care America.  Brown and Talaga falsely billed Medicare for services that were never provided to patients.  The services fraudulently billed included services rendered to patients who were actually dead, as well as services purportedly provided by medical professionals after they had ended their employment and by medical professionals who worked over 24 hours per day.  Evidence showed that Brown forged physician signatures on medical documents, and Talaga directed physicians to create false documentation after she had billed for services that had not been documented or provided.
Source: justice.gov

Claim Status Request and Response

Posted by:  :  Category: Medicare

Providers have a number of options to obtain claim status information from Medicare contractors: •Providers can call the provider help lines for their local Part A and Part B Medicare Administrative Contractor (MAC) and ask to speak to a customer service representative. •Providers can enter data via Interactive Voice Response (IVR) telephone systems operated by Medicare contractors. •Providers can enter claim status queries via direct data entry screens maintained by Medicare contractors. •Providers can send a Health Care Claim Status Request (276 transaction) electronically and receive a Health Care Claim Status Response (277 transaction) back from Medicare. The electronic 276/277 process is recommended since many providers are able to automatically generate and submit 276 queries as needed, eliminating the need for manual entry of individual queries or calls to a contractor to obtain this information. Submission of 276 queries and issuance of 276 responses should be less expensive for both providers and for Medicare. In addition, the 277 response is designed to enable automatic posting of the status information to patient accounts, again eliminating the need for manual data entry by provider staff members. If unsure whether your software is able to automatically generate 276 queries or to automatically post 277 responses, you should contact your software vendor or billing service.
Source: cms.gov

Filing a Medicare Claim and Checking the Status

If you have Original Medicare, the amount you pay at the time you receive a health service will depend on whether your doctor is a Medicare-participating provider and accepts assignment. Medicare-participating providers are on contract with Medicare to accept and treat patients for all Medicare-covered services and supplies. A provider that accepts assignment agrees to accept the Medicare-approved amount as full payment for a covered service or supply. In this instance, the provider is required to file Medicare claims for any services you received, and Medicare will pay the provider directly for those services. The provider is not allowed to charge you to submit the claim.
Source: planprescriber.com

Medicare Eligibility Requirements

Posted by:  :  Category: Medicare

Note: You can qualify for Medicare on your spouse’s work record if he or she is at least age 62 and you are at least age 65. You also may qualify on the work record of a divorced or deceased spouse. Following the Supreme Court’s ruling on the Defense of Marriage Act in June 2013, people in same-sex marriages may qualify on their spouse’s work record if they live in the state where they were wed or in another state that recognizes same-sex marriage, or if they are civilian or military employees of the federal government. It’s currently unclear whether same-sex couples outside of these categories have the same rights — but if you’re in this position, you should apply anyway.
Source: aarp.org

Medicare Eligibility & Requirements

People with limited incomes may qualify for Extra Help to pay for their prescription drug costs. If you qualify, Medicare could pay for up to seventy-five (75) percent or more of your drug costs including monthly prescription drug premiums, annual deductibles, and co-insurance. Additionally, those who qualify will not be subject to the coverage gap or a late enrollment penalty. Many people are eligible for these savings and don’t even know it. For more information about this Extra Help, contact your local Social Security office or call 1-800-MEDICARE (1-800-633-4227), 24 hours per day, 7 days per week. TTY users should call 1-877-486-2048. 
Source: coventryhealthcare.com

Coventry Medicare: Eligibility Requirements

Members in our PPO plans can go to doctors, specialists or hospitals in- or out-of-network. With the exception of emergency or urgent care, it may cost more to get care from out-of-network providers.  Accessing services from in-network providers can cost less than using services of out-of-network providers. Your responsibility will be greater out-of-network when the out-of-network co-insurance is based on the Medicare allowed amount and coinsurance in-network is based on the contracted amount which is probably lower. Coventry provides reimbursement for all covered benefits regardless of whether they are received in-network, as long as they are medically necessary.
Source: coventryhealthcare.com

Who is Eligible for Medicare?

Your eligibility for Medicare is based on your age and your medical condition. If you’re eligible, you can usually sign up for Medicare Part A — hospital care and similar expenses — without paying a premium, based on the years you or your spouse have been working and paying Medicare taxes. If you haven’t put in enough work, the premium, at time of writing, was $407 a year. Part B, which covers doctor visits and other services, costs $104.90 a month, though some high-income individuals pay more.
Source: ehow.com

Consumer Information and Insurance Oversight

Posted by:  :  Category: Medicare

The page could not be loaded. The CMS.gov Web site currently does not fully support browsers with “JavaScript” disabled. Please enable “JavaScript” and revisit this page or proceed with browsing CMS.gov with “JavaScript” disabled. Instructions for enabling “JavaScript” can be found here. Please note that if you choose to continue without enabling “JavaScript” certain functionalities on this website may not be available.
Source: cms.gov

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

Medicare Hospital Compare Quality of Care

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Source: medicare.gov

Contact Information and Websites of Organizations for Medicare

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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

Medicare and Medicaid Help

For Medicare recepients who are researching whether a specific procedure is covered, there is the Coverage Issues Manual. The manual addresses coverages issues for clinical trials, medical procedures, supplies, diagnostic services, prosthetic devices, and nursing services. Medicaid Expansion State by State discussion provided by Coverage Counts Many low-income adults could gain access to Medicaid “a state-based health program” through a provision in the Affordable Care Act health reform law. Each state determines who is eligible for health care under Medicaid; in most states, people who qualify must have a low income and be under the age of 18, pregnant or have specific diseases. The health reform law gives each state the option to expand Medicaid coverage and include all people who earn less than 133 percent of the federal poverty level; Currently, the costs of Medicaid coverage are split evenly between states and the federal government. Under the expansion, the federal government will reimburse at least 90 percent of states’ Medicaid costs. Medicare Primer This booklet is designed to familiarize individuals with the Medicare program with an emphasis on prescription coverage and utilization. The primer contains:
Source: patientadvocate.org

Extra Help with Medicare Prescription Drug Plan Costs

Medicare beneficiaries can qualify for Extra Help with their Medicare prescription drug plan costs. The Extra Help is estimated to be worth about $4,000 per year. To qualify for the Extra Help, a person must be receiving Medicare, have limited resources and income, and reside in one of the 50 States or the District of Columbia.
Source: socialsecurity.gov

West Virginia Bureau for Children and Families

West Virginia Bureau for Children and Families NOTE: You are using an outdated browser. In order to view, use, and enjoy this site to the fullest, we strongly recommend upgrading your browser to one that supports web standards.
Source: wvdhhr.org

Medicare Resources: Extra Help

The Centers for Medicare & Medicaid Services (CMS) requires that all plan sponsors accept evidence presented by a Medicare beneficiary that he or she is eligible for extra help/ Low Income Subsidy (LIS) even if Medicare records show otherwise. Once a beneficiary submits the Best Available Evidence to Cigna-HealthSpring, we will request that CMS update the beneficiary’s LIS status in the CMS system.
Source: cigna.com

Social Security Tax / Medicare Tax and Self

Posted by:  :  Category: Medicare

The United States has entered into social security agreements with foreign countries to coordinate social security coverage and taxation of workers employed for part or all of their working careers in one of the countries. These agreements are commonly referred to as Totalization Agreements. Under these agreements, dual coverage and dual contributions (taxes) for the same work are eliminated. The agreements generally make sure that social security taxes (including self-employment tax) are paid only to one country. You can get more information on the Social Security Administration’s Web site.
Source: irs.gov

Medicare Surtax on Wages and Self

The Additional Medicare Tax was legislated as part of the Patient Protection and Affordable Care Act, and amended by the Health Care and Education Reconciliation Act of 2010. These two laws reformed the health care market by requiring individuals to obtain health insurance or pay a tax penalty. The additional Medicare tax was included as a revenue raiser in that legislation. At the time the legislation was passed, the Joint Committee on Taxation estimated that the Additional Medicare Tax and the Unearned Income Medicare Contribution Tax would together generate an additional $20.5 billion in tax revenue in the year 2013, the first year that the Medicare surtax would be in effect. (Source: JCX-17-10 [pdf].)
Source: about.com

California Health Advocates: Medicare Policy, Advocacy and Education

Posted by:  :  Category: Medicare

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

CMA Health Policy Consultants

2015 will also usher in a new Congress. Many of its leaders and members will likely champion plans to further privatize Medicare. These proposals will likely surface despite increasing reports that Medicare costs and the federal deficit are declining, and that traditional Medicare costs less than private Medicare. Once again we will likely hear about plans to transform Medicare to “Premium Support” (a voucher towards the purchase of private insurance). We will probably read about proposals to increase the age of Medicare eligibility, decrease the value of Supplemental Medicare Insurance (Medigap), redesign Medicare to make it “simpler” (but less useful for most beneficiaries). We urge you to listen carefully for these and other such plans. And respond!
Source: cmahealthpolicy.com

Recovery Audit Contractor Appeals

The inevitable next step… CMS is developing a Unified Program Integrity Contractor (UPIC) strategy that restructures and consolidates the current Medicare and Medicaid integrity audit programs.  Ultimately, this strategy appears to be designed to reduce the vast decentralization of program integrity initiatives and move forward with a more centralized structure. The Center for Program Integrity (CPI), as part of CMS, is implementing a wide range of strategies that CMS believes to be designed to reduce fraud, waste, abuse and other overpayments.  The concept of a unified program integrity strategy involves contractors performing work across the Medicare and Medicaid program integrity continuum. The program incorporates data matching, coordination, and information sharing to identify fraud or abuse that may have “slipped through the cracks” of CMS’ other ongoing initiatives. According to CMS, this unified program integrity strategy is designed to build upon the improvements that CPI has made over the past several years in multiple arenas.  CMS also anticipates that this approach will lay the groundwork for fostering further program integrity coordination with other private and governmental payers across the entire health care industry: (1) Break down the boundaries between Medicare and Medicaid program integrity activities to create a truly holistic and coordinated Medicare/Medicaid program integrity strategy; (2) Create a more unified, coordinated nationwide program integrity strategic framework enabling the CMS to set national goals and priorities (after consultation with the Contractors) to ensure that local or regional program integrity activities are consistent with the CPI’s national-level strategy, while still allowing for some regional variation in program integrity activities to respond to local or regional trends in waste, fraud, and abuse; (3) Further enable cooperation and communication between the various regional program integrity Contractors to ensure a truly national approach to providers or trends that cut across regions; (4) Strengthen the CMS’s national-level direction of the Contractors’ work by ensuring a rapid, accurate flow of information to the CMS about all levels of the contractors’ workload and activities; and (5) Ensure that the CPI’s new and emerging centralized fraud detection mechanisms and other tools, for example the Fraud Prevention System predictive analytics tool (“FPS”) and the Health Care Fraud Prevention Partnership (“HFPP”), are fully and consistently leveraged across the entire nation.​
Source: racaudits.com