Popular questions about Medicare and the Exchange

Posted by:  :  Category: Medicare

The Affordable Care Act required states to establish a health insurance Exchange for people by Jan. 1, 2014. Our state’s Exchange is called the Washington Healthplanfinder and it’s designed to help people shop for and enroll in an individual health plan. If you have health coverage through Medicare, you don’t need to do anything. It will not affect your coverage. Below are some common questions we receive from consumers.
Source: wa.gov

Filing a Medicare Claim and Checking the Status

Posted by:  :  Category: Medicare

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

Submit a Medicare claim online

There are daily and monthly claiming limits. You can claim a maximum of $75 per day or $150 per 30 days per Medicare card and bank account. The monthly limit is calculated as a 30 day rolling limit. If you exceed a claiming limit, your Medicare claim can still be submitted:
Source: gov.au

How to Process a Claim to Medicare

Check your Medicare Summary Notice (MSN) when you receive it in the mail. You can also check your Medicare claims online. Every three months Medicare will mail you a Medicare Summary Notice listing any medical services or supplies that were billed to Medicare within that time frame. If a service or supply does not appear on the MSN, the provider or supplier might not have filed a claim. According to Medicare guidelines, a claim form must be submitted within one calendar year after the year in which you received a medical service or supply.
Source: ehow.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

Pennsylvania Medicare Supplement Plans

The best time to enroll is during the six-month Medigap Open Enrollment Period (OEP). The OEP begins on the first day of the month that a beneficiary is age 65 or older and enrolled in Medicare Part B. During the OEP, a beneficiary has the guaranteed issue right to enroll in a plan of their choosing without undergoing medical underwriting, and insurers cannot charge more, or deny coverage completely during this period. Note: Even during this six-month period, insurers may have the ability to impose a waiting period for pre-existing conditions.
Source: ehealthmedicare.com

2015 Pennsylvania 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

Pennsylvania Medicare Advantage Plans with Part D (Prescription Drug) Coverage

The plans below offer Medicare Advantage and Part D coverage to Pennsylvania residents. Medicare Advantage plans, also known as Medicare Part C, are alternatives to original Medicare. These plans help cover the costs of services provided by hospitals, doctors, lab tests and some preventive screenings. These plans’ Part D component helps cover prescription drugs. Even if a plan’s monthly premium is $0, you would still pay the equivalent of the original Medicare premium. Not all plans shown here will be available to you; enter your zip code to see plans in your area. You can read about whether Medicare Advantage is right for you. If you only want plans with drug coverage, browse Prescription Drug (Part D) Plans.
Source: usnews.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

Medicare Supplement Plans (Medigap Plans) and other Medicare / Health Insurance Plans

A Medicare Supplement plan is a health insurance policy sold by private insurance companies in your state. It provides additional protection for what is not covered by Original Medicare. This insurance is specifically designed to fill the “gaps” in Medicare Part A and Part B coverage.
Source: libertymedicare.com

Find a 2015 PA Medicare Part D Plan

- Cost Sharing – These figures apply to the initial coverage phase of your plan. This is the phase after the initial deductible has been met and before you reach the Coverage Gap (Donut Hole). Plans often cover drugs in “tiers”. Tiers are specific to the list of drugs covered by the plan. Plans may have several tiers, and the copay for a drug depends on which tier the drug is in. Plans can form their own tiers, so you should contact the plan or reference it’s summary of benefits to find out what copays and limitations are associated with each tier. These cost sharing figures DO NOT necessarily apply to the Coverage Gap. The plan may have a separate copay/coinsurance for the same drug while in the Coverage Gap. (Search Tip: If you would like to reduce the plans shown to just plans that have a tier 1 (Generics) co-pay of up to a certain value (ex: $0 co-pay), enter the value (ex: 0) in the “Max. Co-pay Tier 1 (Generics)” field.)
Source: q1medicare.com

Medicare News and Updates

Posted by:  :  Category: Medicare

Have you heard the news? The Department of Health and Human Services (HHS) will start removing Social Security numbers from all newly-issued Medicare identification cards going forward — though, it won’t happen overnight. Due to the large number of cards needing changes, HHS has four years to issue modernized cards to new beneficiaries, and another four years to issue updated cards to existing beneficiaries.
Source: medicaremadeclear.com

Caregiver Information Archives

If you’re like a lot of people, you’ll be spending the holidays with your elderly parents or other family members. This is an ideal time to find out if they’re taking good care of themselves or if they’re beginning to show signs of self-neglect.  
Source: medicaremadeclear.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 Plan Finder for Health, Prescription Drug and Medigap plans

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

Health Insurance, Dental Insurance & Other Insurance Plans

Saving money on health care can be a challenge. But we’re here to help. There are a number of ways to reduce your out-of-pocket costs. For example, choose an in-network doctor or hospital instead of one that’s out of network. Another good way to save is to choose a plan that is compatible with a tax-advantaged health savings account.
Source: aetna.com

Michigan Medicare Health Insurance Plans

Medicare is a health insurance program run by the government for people age 65 and older, and for people under 65 with certain disabilities. Understanding more about Medicare will make it easier to choose the right plan. Our Medicare 101 section has resources to help you do that.
Source: bcbsm.com

Best Medicare Supplement Insurance Quotes

Posted by:  :  Category: Medicare

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

Medicare Supplement Plans & Quotes

Turning 65 is stressful, and the amount of information people receive leading up to their birthday is astounding. From the stacks of mail piling up on your desk, to the seemingly endless phone calls and quotes from insurance companies and agents, the task of gathering honest, unbiased information can feel impossible. Our goal is to offer what nobody else will, which is why we provide medicare supplement quotes, financial ratings, benefit information, application fee data, price history, and pricing methodology for all supplemental insurance companies in one clean, concise report. Our free, no obligation service is designed to give you the information you need regarding Part D and Medicare Supplement Plans in order to make an educated purchasing decision. In addition, we offer continued support for all of our customers to ensure they have no claims or billing issues. On an annual basis we review all medicare supplement insurance quotes and plan options in an effort to notify our customers of any new or better plans that may be available.
Source: medicaresupplementshop.com

Medicare Supplement (Medigap) Insurance Plans

MedSupp plans can help pay Original Medicare’s copayments and deductibles. Each type of plan offers a different level of coverage, and is named with a different letter (such as Plan A). The plans are standardized, so that all plans of the same letter offer the same benefits. In other words, the benefits for a Medicare Supplement Plan D enrollee in Rhode Island are the same for a Medicare Supplement Plan D enrollee in Tennessee. However, the premiums can differ among these private insurance companies.
Source: planprescriber.com

Medicare Supplemental Insurance Policies at Mutual of Omaha

Every Medigap policy must follow federal and state laws designed to protect you, and it must be clearly identified as Medicare supplement insurance. Medigap insurance companies can only sell you a standardized Medigap policy identified by letters A through N. Each standardized Medigap policy must offer the same basic benefits, no matter which insurance company sells it. Cost is usually the only difference between Medigap policies sold by different insurance companies
Source: mutualofomaha.com

Medicare Part D and TRICARE

Posted by:  :  Category: Medicare

If TRICARE-Medicare beneficiaries enroll in a prescription drug plan that adds prescription coverage to the original Medicare plan, Medicare is primary and TRICARE, as second payer, will pay their out-of-pocket costs for TRICARE-covered medications and the Medicare deductible and cost shares. When beneficiaries become responsible for 100 percent of the drug costs under the Medicare Part D drug plan, the TRICARE pharmacy benefit becomes primary payer and the beneficiary is responsible for applicable TRICARE pharmacy copays and cost shares. Once the TRICARE catastrophic cap is met, TRICARE pays 100 percent for TRICARE-covered medications.
Source: military.com

Medical Benefits in Retirement – TRICARE For Life and Medicare

Part B covers most of the costs associated with physician fees, lab fees and durable medical equipment costs. Typically, Part B will pay 80 percent of the costs of these services, and leave you with 20 percent of the tab, though some services have a higher coinsurance amount. You’re automatically enrolled when you turn 65, in most cases. There is a premium for Part B coverage, though: $99.90 per month. There’s also an annual deductible of $140 every year.
Source: militaryauthority.com

Medicare Dental Plan Overview And Private insurance Details For Nationwide Coverage

Posted by:  :  Category: Medicare

Keep in mind that usually the mothly premium will affect the amount of benefits you receive in most cases. Most “insurance plans” such as indemnity, HMO or PPO plans will require a waiting period of 6 months to 1 year for Major services. Discount plans are NOT Insurance but usually offer full benefits under the plan from day 1. We have researched most of the companies and plans. And have included our top choices on this website for your convenience. Please Visit
Source: medicaredentalplan.com

Health Insurance, Dental Insurance & Other Insurance Plans

Saving money on health care can be a challenge. But we’re here to help. There are a number of ways to reduce your out-of-pocket costs. For example, choose an in-network doctor or hospital instead of one that’s out of network. Another good way to save is to choose a plan that is compatible with a tax-advantaged health savings account.
Source: aetna.com

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

Does Medicare Cover Dental?

Dentures can be a costly investment for those living on a fixed income. The cost of dentures may be $300 to $4,000 per plate, depending on the extensiveness of the denture and its quality. A denture plate is a removal dental apparatus that replaces teeth and gum tissue. A complete denture plate replaces all teeth in the upper jaw or lower jaw. A partial plate replaces some teeth within either jaw. Consequently, if a senior needs both upper and lower plates than the estimate price may be in the range of $600 to $8,000 or more. Original Medicare Parts A and B never cover dentures. In some states and under some conditions, Medicaid (the state-run health program for groups of low income people, include some dental coverage. Given the high costs of dentures, many seniors are incented to comparison shop costs among dentists in order to find affordable dentures.
Source: healthpocket.com

Medicare Dental Insurance

Dental insurance coverage is one of the most common questions for seniors after they settle their Medicare Supplemental Insurance and Medicare Part D coverage. "How about dental" almost always follows the Medicare Supplement Insurance, and drug plan enrollment. Unfortunately Medicare has no dental insurance coverage. Discount Dental plans, Dental, Vision, and Hearing combinations, or Dental only plans are available in most areas. We believe the first and second choice provide the best value. The following information will help you compare these two options.
Source: medicaredentalcenter.com

Extra Help with Medicare Prescription Drug Plan Costs

Posted by:  :  Category: Medicare

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: ssa.gov

www.Q1Medicare.com Your Source for Medicare Part D Plan Information

You can enroll into a stand-alone Medicare Part D Prescription Drug plan or a Medicare Advantage plan during the Annual Enrollment Period (or AEP) or open enrollment period starting October 15th and continuing for seven weeks through December 7th with your newly selected Medicare plan starting on January 1st of the following year. Please note that if you are just turning 65 or are newly eligible for Medicare, you will be granted a seven (7) month enrollment period when you can join a Medicare Part D or Medicare Advantage plan. The seven month period begins three months before your Medicare eligibility (or birthday) month, includes your eligibility month, and continues for three months after your Medicare eligibility month. However, your Medicare plan can begin no sooner than the first day of your Medicare eligibility month. Enrolling in a Medicare Part D or Medicare Advantage plan is easy and takes little time. : : Click here if you already know       which Medicare Part D plan you want : : Click here to search for a       Medicare Part D plan : : Click here to search for a       Medicare Advantage plan The good news about enrollment is that you always pay the same amount for a Medicare D plan or Medicare Advantage plan, no matter where or how you enroll. As an expanded feature, we now provide enrollment options for all 2015 Medicare Part D plans and Medicare Advantage plans across the country. If you wish, you can also enroll directly with Medicare (1-800-Medicare) or with an insurance agent or the Medicare plan provider. No matter how you enroll in to a Medicare plan, the enrollment result should always be the same and in 7 to 10 business days you should receive your Medicare Part D new Member information. Once enrolled into a Medicare Part D or Medicare Advantage plan, you can contact the plan’s Member Services department with any questions or concerns. The toll-free number will be on the back of your Member ID card. Please note that the Medicare Advantage Dis-Enrollment Period (MADP) for Medicare Advantage Plans begins January 1st and continues through February 14th — during the MADP members of Medicare Advantage plans can switch back to original Medicare and join a stand-alone Medicare Part D drug plan. Please also note that you may be eligible for a Special Enrollment Period (SEP) allowing you to change Medicare plans outside of the AEP. Click here to read more about Special Enrollment Periods.
Source: q1medicare.com

Medicare Part D coverage gap

In 2006, the first year of operation for Medicare Part D, the donut hole in the defined standard benefit covered a range in true out-of-pocket expenses (TrOOP) costs from $750 to $3,600. (The first $750 of TrOOP comes from a $250 deductible phase, and $500 in the initial coverage limit, in which the Centers for Medicare and Medicaid Services (CMS) covers 75 percent of the next $2,000.) In the first year of operation, there was a substantial reduction in out-of-pocket costs and a moderate increase in medication utilization among Medicare beneficiaries, although there was no evidence of improvement in emergency department use, hospitalizations, or preference-based health utility for those eligible for Part D.
Source: wikipedia.org

Medicare Part D Plans, Prescription Drug Plan (PDP)

First Health Part D First Health Part D is a Medicare-approved Part D sponsor. Enrollment in our plan(s) depends on contract renewal. 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, premium and/or copayments/coinsurance may change on January 1 of each year. You must continue to pay your Medicare Part B premium. 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. This information is available for free in other languages. Please call our customer service number at 1-855-389-9688 (TTY/TDD 711), 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.
Source: coventryhealthcare.com

How Part D works with other insurance

While prescription drug coverage is an essential health benefit, prescription drug coverage in a Marketplace or SHOP plan isn’t required to be at least as good as Medicare Part D coverage (creditable). However, all private insurers offering prescription drug coverage, including Marketplace and SHOP plans, are required to determine if their prescription drug coverage is creditable each year and let you know in writing.
Source: medicare.gov

Growth In Medicare Spending Per Beneficiary Continues To Hit Historic Lows

Posted by:  :  Category: Medicare

The aging of the US population will put strain on the financing of the Medicare program. Although growth in spending per beneficiary is projected at or below the rate of GDP per capita, the number of Medicare beneficiaries is projected to grow at approximately 3% annually. As a result, aggregate Medicare spending will account for a growing share of GDP over the next decade. As shown in Exhibit 3, most of the increase in Medicare spending as a fraction of GDP from 2013 to 2035 is projected to result from the effects of aging and growth in the number of beneficiaries, with very little of it a result of excess growth in expenditures per beneficiary. Further reducing per beneficiary cost growth below the projected level of GDP+0 is an important component of responding to fiscal pressure. But recent reductions in the growth of Medicare per beneficiary spending and projections for the next decade offer strong evidence that we have made great progress. Moreover, the Affordable Care Act provides a platform for the development of innovations in the delivery of and payment for health care, with the potential for significant improvements in both the quality of health care and its cost-efficiency. Such innovations would not only improve health care for Medicare beneficiaries in the future but also for the population at large.
Source: hhs.gov

Medicare Spending By Year

On June16, 2015, the Congressional Budget Office released its annual Long Term Budget Outlook for 2015, which projects federal spending and revenue out into the 2080s.  As before, the CBO study shows that federal health-care programs will eat the budget, with federal spending exceeding 35 percent GDP by the end of the century while federal revenue stays below 25 percent GDP. UsGovernmentspending.com has updated its chart of the CBO Long Term Budget Outlook here.  You can download the data and also view CBO Long Term Budget Outlooks going back to 1999.
Source: usgovernmentspending.com

Cracking Down On $70 Billion Worth Of Medicare Fraud

What may at first seem like an accounting disagreement at a big government agency actually has profound implications for U.S. policy and society. Congress is presently mired in an endless debate about when—and how much—to cut entitlement programs in an effort to reduce the federal deficit. The Obama administration proposes trimming $248 billion over 10 years from Medicare alone. Yet if fraudulent losses could be reduced by just a few percentage points, the issue becomes moot—and the medical support that tens of millions of Americans rely upon could continue uninterrupted. “The annual combined cost of Medicare and Medicaid is between $800 and $900 billion annually,” Sparrow says. If only 10% is lost to fraud, he notes, that’s $80 billion a year—pointing to a figure even higher than the $70 billion cited by the GAO. “But if it’s 20% or 30%?” he asks. “We’d easily find $200 billion over 10 years. That means you wouldn’t need to cut reimbursement rates for providers. You wouldn’t need to restrict insurance coverage. You wouldn’t have to increase deductibles. Getting hold of this problem is a much healthier way of dealing with the cost- control imperative than through indiscriminate cutbacks.” The question thus becomes whether the politicians in Washington who are now trying to cut spending on medical care are actually wrestling with the wrong problem. Which means they might settle on the wrong solution.
Source: fastcompany.com

The Mystery of the Missing $1,200 Per Person: Can Medicare’s Spending Slowdown Continue?

Health care observers are still scratching their heads trying to explain why Medicare spending is growing so slowly.  A CBO analysis shows the Great Recession did not have the same effect on Medicare that it had on the slowdown in health care spending generally, which has been documented by our Kaiser colleagues. It is clear that the Medicare savings provisions in the ACA, such as reductions in provider payment updates and Medicare Advantage payments, have played a major role, and the changes included in the law may be having a bigger effect than was expected soon after the law passed.  In addition, the Budget Control Act of 2011 also exerted downward pressure on Medicare spending through sequestration that reduced payments to providers and plans by 2 percent beginning in 2013.  And yet even after incorporating these scheduled payment reductions in the baseline, CBO has continued to lower its projections of Medicare spending.
Source: kff.org

How Much of the Medicare Spending Slowdown Can be Explained? Insights and Analysis from 2014

The slow growth in Medicare spending has also led to relatively modest increases in Medicare premiums and cost sharing, which are indexed to rise with program costs. For example, Medicare Part B premiums, which are pegged to growth in Part B spending, were unchanged between 2013 and 2014 and will be the same in 2015 as in the previous two years. And the Medicare Trustees project that the Independent Payment Advisory Board (IPAB)—a controversial but not yet appointed or convened independent entity which was authorized by the ACA as a spending backstop—will not be required to issue recommendations for Medicare savings until 2022, due to relatively low projected spending trends.
Source: kff.org