Medicare Payment & Reimbursement

Posted by:  :  Category: Medicare

Highlights Summary of the Medicare Access and CHIP Reauthorization Act of 2015 – 4/16/15 This act has implications for the sustainable growth rate, therapy cap, PQRS, postacute care providers, durable medical equipment orders, renewal of MAC contracts, and telehealth, as well as other Medicare payment provisions.
Source: apta.org

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) 2013 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

New York Medicare Advantage Plans for 2015 from Touchstone Health

We understand that everyone has different health care needs. That is why we have a robust selection of Medicare plans to choose from including plans with or without prescription drug coverage and a plan for those who qualify for Medicaid.
Source: touchstoneh.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 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.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

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

About Medicare health plans

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.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

Ohio Department of Insurance

Please Note: You are viewing the non-styled version of Ohio Department of Insurance. Either your browser does not support Cascading Style Sheets (CSS) or it is disabled. We suggest upgrading your browser to the latest version of your favorite Internet browser.
Source: ohio.gov

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

Universal Healthcare Medicare Plans

Posted by:  :  Category: Medicare

Universal Health Care has been in business for only 8 years, and is a Medicare/Medicaid health insurance provider based in Florida. They provide managed care services for government sponsored health care programs, focusing on Medicare and Medicaid. They offer a variety of health insurance products, including Medicare Advantage plans in 13 states. Their informational materials and plans are currently pending approval from the Center for Medicaid and Medicare, and are therefore subject to change.
Source: seniors-health-insurance.com

Will Obamacare Kill Medicare?

The Cleveland Clinic bombshell exploded shortly after United Health, America’s largest sponsor of Medicare Advantage plans, decided to drop thousands of doctors from its networks in 2014. The Medicare Advantage program, which allows private health plans to compete in providing care, enrolls about 28 percent of all Medicare beneficiaries. The Wall Street Journal reported that United sent pink slips to physicians in at least ten states, guaranteeing a reduction of doctors in their Medicare Advantage offerings. Naturally, senior and disabled persons face a new uncertainty about whether or not they will be able to keep their doctors. Recall that other high-profile presidential promise: If you liked your doctor, you could keep your doctor. Period.
Source: nationalinterest.org

Top 119 Complaints and Reviews about AARP Medicare Supplemental Insurance

I changed companies and thought I was doing the right thing with this company. I had to have my doctor call in my prescriptions for the new year. When I received them, I found out that one of my medicines is not covered and they charged me for this. My old company charged $8.00 a month. I spent almost an hour on the phone talking to 3 different departments and they did not appear to be very knowledgeable (different ideas and answers from the previous department). Maybe someone could have called me about this. I am really sorry I changed my Medicare insurance. Now, I am stuck for the rest of the year and who knows what other surprises there will be. Go with a small company – they have great customer service and always give you the correct answer; they want your business. AARP United Health Care Complete seems to be more expensive. OptumRx is slow and sends things out incomplete; then, another package comes, and when you call about a prescription, they tell you it is on back order, which I was not told about until I called; by then, I am getting low on meds. I should have not changed companies.
Source: consumeraffairs.com

Florida Nursing Homes; FL Rehab and Extended Care Facilities

676 Florida Nursing Homes and rehabilitation, convalescent facilities listed in the Compare Nursing Homes database at www. medicare.gov. We do not sell, endorse or recommend any service, product or particular facility. This information could change at anytime.
Source: dibbern.com

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.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

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

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

Investors now have a heightened interest in behavioral health after new laws have gone into effect giving treatment for mental disorders payment parity with physical illnesses. Insurers and government payers also are beginning to see treatment of behavioral health disorders as a wise investment.
Source: modernhealthcare.com

Medicare Hospital Benefit Period

Posted by:  :  Category: Medicare

Beyond 90 days of inpatient hospital care in the same benefit period, you are responsible for 100 percent of the costs. However, Medicare allows you a further 60 days of “lifetime reserve” days. This means that for the rest of your life you can draw on any of these 60 days—but no more—to extend Medicare coverage in any benefit period. In 2014, your share of the cost is $608 a day. But if you have any type of Medicare supplemental insurance (also known as medigap), your policy covers an additional 365 life-time reserve days, with no copays.
Source: aarp.org

What's a Benefit Period in Medicare Part A? It Pays to Know

You may be in the hospital more than once during one benefit period. For example, imagine you are in the hospital for a short stay and then released. Now imagine that you go back into the hospital the next week for the same health problem. That means you have two hospital stays within one benefit period. You would pay one deductible.
Source: medicaremadeclear.com

Medicare Benefits, Policy and Eligibility Guide

The clinical depression diagnosis once carried with it a stigma of being something that happened to “weak” or “unstable” people. As science and medicine have advanced people have begun to understand that this is actually just the struggles of an unbalanced body. Now, insurance companies or groups like Medicare are recognizing the struggle and adding […]
Source: medicare-benefits.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 in South Carolina

Posted by:  :  Category: Medicare

Medicare Advantage Organizations and prescription drug plan sponsors must have a contract with Medicare in order to sell Medicare insurance plans (such as a Medicare HMO or a Medicare Part D prescription drug plan). Depending on the terms of the contract between the plan and Medicare, not every plan is available statewide or in all service areas. Each year, the plan must renew their contract with Medicare, so the availability of a plan in a specific service area is subject to change as a result of the annual contract renewal.
Source: ehealthmedicare.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

2015 Medicare Advantage Plans Available to Residents of South Carolina

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

South Carolina Medicare Supplement Plans

The best time to enroll in a Medicare Supplement plan is during the six-month Medigap Open Enrollment Period (OEP) that begins on the first day of the month that you are 65 years old or older and already enrolled in Medicare Part B. During the Medigap OEP you may enroll in any Medigap plan offered by any insurer in your area without submitting to a medical underwriting check. While you can still enroll in Medigap after the Medigap OEP, an insurer may ask for a medical background and you could have pre-existing condition restrictions placed on your coverage. You may also be charged more for Medigap coverage or even denied coverage completely.
Source: ehealthmedicare.com

2015 South Carolina Medicare Part D Prescription Drug Plan Highlights www.Q1Medicare.com

Coverage Gap the Donut Hole: In the CMS Standard Plan, the beneficiary must pay the next $3720 in drug costs (the Donut Hole). The Healthcare Reform provides that for Plan Year 2015, ALL formulary generics will have at least a 35% discount and ALL brand drugs will have at least a 55% discount in the coverage gap. The Gap Coverage Types discussed in this section are in addition to the Healthcare Reform mandated discounts. In our chart, you will see one of the following:
Source: q1medicare.com

Nursing Homes in South Carolina; SC Convalescent Homes, Nursing Home Directory

177 South Carolina Nursing Homes and rehabilitation, convalescent facilities listed in the Compare Nursing Homes database at www. medicare.gov. We do not sell, endorse or recommend any service, product or particular facility.
Source: dibbern.com

Application status lookup tool

Posted by:  :  Category: Medicare

First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.
Source: fcso.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

Claim Status Request and Response

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

Durable medical equipment (DME) coverage

Posted by:  :  Category: Medicare

Medicare will only cover your DME if your doctors and DME suppliers are enrolled in Medicare. Doctors and suppliers have to meet strict standards to enroll and stay enrolled in Medicare. If your doctors or suppliers aren’t enrolled, Medicare won’t pay the claims submitted by them. It’s also important to ask your suppliers if they participate in Medicare before you get DME. If suppliers are participating suppliers, they must accept assignment. If suppliers are enrolled in Medicare but aren’t “participating,” they may choose not to accept assignment. If suppliers don’t accept assignment, there’s no limit on the amount they can charge you.
Source: medicare.gov

Medicare Coverage Database – Centers for Medicare & Medicaid Services

Contextual Help & Page Help – Contextual Help is a new feature that provides users with the ability to receive onscreen help for specific elements on the page. To use the feature, click the "Contextual Help" link and move the mouse to the onscreen location of the associated page element. The user can turn the feature off when help is no longer required. Users who are unable to use this feature, or who prefer to have a link to a single page of help for the entire page, may continue to use the "Page Help" link to get assistance.
Source: cms.gov

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

Medicare Coverage Policy on Speech

For coverage under Part A, the extended care benefit provides comprehensive coverage, including any medically necessary durable medical equipment (DME). If a Medicare beneficiary has a medical need for DME during the course of the Part A stay, the inpatient facility is obligated to furnish it. Prior to April 1, 2014, Medicare beneficiaries who owned the equipment may have furnished their own SGD, instead of depending on the extended care benefit. This is still an option for beneficiaries who take over ownership of the equipment after 13 months of continuous Part B rental payments. However, if the beneficiary enters an inpatient facility under a covered Part A stay and is in the middle of the 13-month capped rental period under Part B for the item, it is the responsibility of the inpatient facility to ensure that the beneficiary has access to this equipment that is medically necessary. The next monthly rental payment to the supplier cannot be made by Medicare until the patient is discharged from the inpatient stay. The supplier may enter an agreement for the facility to continue payment during the stay, or the patient can furnish his/her own device.
Source: asha.org