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 Policy on Speech

The LCDs also include the requirement of the physician face-to-face visit prior to the prescription of the SGD. The face-to-face physician visit originates from the Affordable Care Act and mandates that the documentation of the visit with the physician demonstrates the beneficiary was evaluated and/or treated for a condition that supports the need for the SGD. A dispensing order is not sufficient documentation; a Written Order Prior to Delivery (WOPD) is required and must be forwarded to the supplier prior to the delivery of the SGD. In the case of an audit, the supplier is responsible for the WOPD.
Source: asha.org

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

UnitedHealthcare Medicare Plans

Posted by:  :  Category: Medicare

A Medicare Advantage Plan (Part C) is a type of Medicare health plan offered by a private insurance company that contracts with Medicare to provide Original Medicare (Parts A and  B) benefits. Medicare Advantage Plans can combine hospital, doctor and drug coverage in one plan, and may include extra benefits not offered by Original Medicare.
Source: uhc.com

CMS 855A Medicare Application | CMS 855A Medicare Application made easy

Posted by:  :  Category: Medicare

We have assisted well over 1,200 Home Health Care Agencies with the completion of the CMS 855 A Medicare Application and Medicare Accreditation process. We complete your Home Health Care Agency’s CMS 855 A Medicare Application and paperwork requirements. The recent and ongoing changes to licensing standards and regulatory requirements can make the completion of the CMS 855 A Form challenging. At 21st Century Health Care Consultants, you provide us the Medicare Application information required, we do the rest; its that simple. We complete your CMS 855 A Medicare Application and include the required Civil Rights Package for your State. We offer a full Home Health Care Medicare Accreditation Program, we will get your Home Health Care Agency Medicare Accredited, no question.
Source: cmsmedicareapplication.com

Free Government Cell Phone Providers in Arizona

Posted by:  :  Category: Medicare

Think of Arizona and you think of natural wonders like the Grand Canyon and the Petrified Forest and those giant Saguaro cactus (or is it cacti?). Add in the sunshine and warm weather and the last thing you’d think of is poverty. But much to our surprise, the Census Bureau rates Arizona as the state with the second highest poverty level.
Source: freegovernmentcellphones.net

Senior Living Directory and Aging Resources

Posted by:  :  Category: Medicare

Senior living encompasses senior housing communities and care choices that include independent living, assisted living facilities, Alzheimer’s and memory care, aging in place, home health care and more; how to pay for your senior lifestyle so you don’t outlive your money; and senior health information so you can fully enjoy the best years of life.
Source: seniorliving.com

Assisted Living: MedlinePlus

Assisted living is for adults who need help with everyday tasks. They may need help with dressing, bathing, eating, or using the bathroom, but they don’t need full-time nursing care. Some assisted living facilities are part of retirement communities. Others are near nursing homes, so a person can move easily if needs change.
Source: nih.gov

Assisted Living Facilities .org

AssistedLivingFacilities.org strives to serve as the informational resource for assisted living in the United States. We list information on over 36,400 state-licensed assisted living facilities and try to explain the rules and regulations of each state. We try to offer as much useful information as possible to help you decide if assisted living is a good option, and if so, to select the best facility possible.
Source: assistedlivingfacilities.org

Senior Living & Assisted Living Info From SeniorLiving.Org

3. Once you have checked out your special options and finances, it is time to look for local option. You can enter your desired location into the search bar at the top of any page or browse by selecting a state and then city below. Tthen click on the tabs at the top to narrow your selection to a specific type of care in that area. Then you will see a list of your local options for the type of care you have selected. If a service qualifies for a special group, they will have an icon next to their listing. Click on the link to any service to get more information including types of care, surrounding options, costs, contact information, photos and more.
Source: seniorliving.org

UnitedHealthcare Medicare Plans

Posted by:  :  Category: Medicare

A Medicare Advantage Plan (Part C) is a type of Medicare health plan offered by a private insurance company that contracts with Medicare to provide Original Medicare (Parts A and  B) benefits. Medicare Advantage Plans can combine hospital, doctor and drug coverage in one plan, and may include extra benefits not offered by Original Medicare.
Source: uhc.com

Medicare Supplemental Insurance Plans

This section will help you learn about the basics of Medicare Parts A and B, Medicare Advantage Plans (also known as Part C), Prescription Drug Plans (also known as Part D) and standardized Medicare supplement insurance plans.
Source: aarpmedicaresupplement.com

Obamacare’s Impact on Medicare Advantage

Posted by:  :  Category: Medicare

Build on the steady progress in risk adjustment. Risk adjustment is a tool used to address selection bias in Medicare Advantage and other private insurance programs. The goal is to mitigate an insurer’s ability to tailor plans to attract a disproportionate share of the most profitable enrollees—healthier enrollees that consume less medical services. Every major Medicare reform proposal, based on premium support, would provide risk adjustment or significantly improve the risk-adjustment formulas or mechanisms that currently exist in the MA or Medicare Part D program. Risk adjustment could either be prospective or retrospective. Prospective risk adjustment already characterizes Medicare Advantage and Medicare Part D, where government per capita payments are adjusted by demographic factors, such as age, sex, institutional or Medicaid status, and medical conditions. Retrospective risk adjustment—back-end adjustments—would be based on new pooling arrangements, such as a risk-transfer pool. In that arrangement, health plans that attracted higher-risk or more costly patients would be cross-subsidized by plans that attracted fewer high-risk or less costly patients. The value of these types of arrangements is that they would be based on hard data and not on educated guesswork or projections. The Wyden–Ryan plan, for example, includes such an approach. The Heritage proposal would include both prospective and retrospective risk adjustment. Applying the lessons from MA’s risk-adjustment experience could mitigate the risks that only the unhealthy would be stuck in Medicare fee-for-service plans, leaving the plans’ costs to escalate and grow further away from the premium support benchmark, and thus more expensive for enrollees. Over the past decade, as Alice Rivlin and others have noted, the risk-adjustment mechanism used in Medicare Advantage has significantly improved and succeeded in reducing favorable selection in the program. In the future, with the adoption of defined-contribution financing for the entire Medicare program, one can expect further refinements and innovative approaches to adjusting government per capita payments. One particularly interesting approach has been developed by Zhou Yang, professor of economics at Emory University. Professor Yang’s proposal, to be implemented within an environment of competitive health plans, would tie Medicare payments to positive behavioral changes: Enrollees would be rewarded for enrollment in wellness or preventive-care programs that promote a healthier (and thus less costly) lifestyle.[44]
Source: heritage.org

Mercy Maricopa Integrated Care

Mercy Maricopa became the Regional Behavioral Health Authority (RBHA) for Maricopa County on April 1, 2014. We offer two health plans: Mercy Maricopa and Mercy Maricopa Advantage. Mercy Maricopa serves people who qualify for RBHA services. Mercy Maricopa Advantage serves people who qualify for RBHA services, have Medicaid, have been determined to have a serious mental illness (SMI) and have Medicare. Learn about eligibility and how to become a member.
Source: mercymaricopa.org

The University of Arizona Health Plans

El 28 de febrero de 2015, The University of Arizona Health Network se incorporó con Banner Health. Banner Health comparte la responsabilidad de Maricopa Care Advantage (MCA, por sus siglas en ingles) de proporcionar un cuidado de salud excelente. Esta unión, con uno de los proveedores de mayor excelencia en el cuidado de salud en el Estado, también tiene el potencial para mejorar la calidad de servicios que los miembros de MCA reciben y mejorar el acceso en general de cuidado de salud. Pero lo más importante, la unión no tendrá repercusiones en los beneficios de cuidado de salud recibidos por los miembros y no habrá cambios en la red de proveedores del plan. MCA continuará ofreciendo el mismo nivel de calidad de atención al cliente y de servicio que ha proporcionado históricamente. Conforme sigan las negociaciones de contrato con Banner Health, nosotros lo mantendremos informado. Mientras tanto, si tiene cualquier pregunta, nos puede llamar al 1-877-874-3935 de lunes a viernes, de 8:00 a.m. a 8:00 p.m. TTY 711           
Source: mcareaz.com

Aetna Medicaid Administrators LLC

With an aging population, rising health care costs and strained budgets, quality health care is an urgent national priority. Aetna Medicaid Administrators LLC (Aetna Medicaid) is an industry leader in coordinating care and controlling costs.
Source: aetnabetterhealth.com

Easy Choice Health Plan (HMO)

If you are looking for a Medicare Advantage Prescription Drug Plan that not only allows for “one stop service” for all your physician, hospital and prescription drug needs, but also provides additional, non Medicare covered benefits, at virtually no cost to you, you’ve come to the right place! Easy Choice Health Plan (HMO) is a federally approved Medicare Advantage Prescription Drug (MAPD) and Special Needs Plan (SNP) designed to provide medical and prescription drug coverage for qualifying individuals in Los Angeles, Alameda, Fresno, San Diego, Santa Clara, Stanislaus, Riverside, Orange, San Joaquin, and San Bernardino counties, California.
Source: easychoicehealthplan.com

Medicare Benefits Schedule (MBS)

Posted by:  :  Category: Medicare

MBS service statistics broken down by Commonwealth Electoral Division (CED) are available in the PDF files below. File 1 details Medicare Safety Net statistics for the 2010 calendar year of service by CED and File 2 details Medicare Bulk Billing statistics for the 2010 – 11 financial year of processing by CED. It is important that you read all notes on these files.
Source: gov.au

Child Dental Benefits Schedule

financial assistance under the Military Rehabilitation and Compensation Act Education and Training Scheme (MRCAETS) and cannot be included as a dependent child for the purposes of Family Tax Benefit because they are 16 years or older
Source: gov.au

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

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

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 Supplement Insurance Quote Engine

In addition to Medicare supplement insurance, we are pleased to be participating in the Medicare Advantage market. The Medicare Advantage policy is a low cost alternative to a Medicare supplement policy and is especially advantageous for those less than 65 years old. The Private Fee For Service (PFFS) is a type of Advantage plan that allows Medicare recipient to visit any doctor, any hospital, anywhere. Therefore, many Medicare recipients are well served by the lower cost Private Fee For Service plan.
Source: bestmedicaresupplement.com

Medicare Supplemental Insurance

Finding the best Medicare Supplemental insurance, Medicare Advantage, and Medicare Part D has gotten more complicated nearly every year. In 2010 Medicare Supplement Insurance added 2 new plans Medigap plan N and Medigap Plan M. At the same time they eliminated several other Medicare Supplement options. Medicare Advantage insurance plans redefine benefits and premiums every year. And, with future Medicare subsidies uncertain due to changing regulation from healthcare reform who can keep up. For many individuals Medicare Supplement Insurance is becoming the best option. Unfortunately, comparing Medicare Supplemental Insurance Plan premiums (Medigap) and Medicare Advantage plans can be a time consuming endeavor. Our highly trained insurance advisors can explain all of your supplemental Insurance options, and assist in finding the best Medicare supplement and Medicare Part D combination that best fits your specific needs. With all the options affecting Supplement insurance and Part D it makes sense to have an expert assist you through the maze.
Source: mysenioradvisorsgroup.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

How to Reform Medicare: First Stage to Fix the Current Program

Posted by:  :  Category: Medicare

[5]The significant differences in official long-term projections, including projections of the program’s unfunded liability, reflect the differences in agency assumptions, particularly about the likelihood of the continuation of current law. The Medicare Trustees and the Congressional Budget Office (CBO) are required to make projections under current law, which assumes, for example, that the large Medicare Part A payment reductions are sustainable and that the projected 29.4 percent reduction in Medicare physician payment will be implemented in 2012. The Office of the Actuary in the Centers for Medicare and Medicaid Services (CMS) makes projections based on the premise that key elements of current law are simply “unworkable.” See John D. Shatto and M. Kent Clemens, “Projected Medicare Expenditures Under an Illustrative Scenario with Alternative Payment Updates to Medicare Providers,” Centers for Medicare and Medicaid Services, Office of the Actuary, May 13, 2011, at https://www.cms.gov/ReportsTrustFunds/downloads/2010TRAlternativeScenario.pdf (September 19, 2011).
Source: heritage.org

2015 Medicare Part D Program Compared to 2014, 2013, 2012 and 2011

Proposal in the 2015 Advanced Notice: This rule proposes to revise the definition of negotiated prices to require all price concessions from pharmacies to be reflected in negotiated prices. The proposed rule would provide greater cost savings for beneficiaries in return for offering preferred cost sharing so that sponsors cannot incentivize use of selected pharmacies, including the sponsors’ own related-party pharmacies that charge higher rates than their competitors. Also, CMS may request that Part D plans increase the number of pharmacies offering preferred, or lower, cost sharing as CMS is concerned that some plans that offer preferred cost sharing do not provide beneficiaries with sufficient access to the lower cost sharing at select network pharmacies. The intent of this policy will be to ensure that beneficiaries are not misled into enrolling in a plan only to discover that they do not have meaningful access to the advertised lower cost sharing. From the 2015 Announcement: Although we [CMS] are not adopting any network adequacy standards at this time, sponsors should be aware that we are continuing to monitor beneficiary access to preferred cost sharing in plans that purport to offer it. For the 2014 and 2015 plan years, we [CMS] will continue to review the retail networks of plans offering preferred cost sharing and will continue to take appropriate action regarding any plan whose network of pharmacies offering preferred cost sharing appears to offer too little meaningful access to the preferred cost sharing. For instance, a stand-alone PDP that offers preferred cost sharing at only seven pharmacies in a PDP region may be asked to increase the number of pharmacies offering preferred cost sharing or to restructure its benefit design during the bid negotiation process. The intent of these negotiations will be to ensure that beneficiaries are not misled into enrolling in a plan only to discover that they do not have meaningful access to the advertised lower cost sharing. We [CMS] note that beginning in 2015, we [CMS] will no longer use the terms "preferred" and "non-preferred" to describe network pharmacies, but rather will describe such pharmacies as offering standard or preferred cost-sharing.
Source: q1medicare.com