Annual Statistical Supplement, 2011

Posted by:  :  Category: Medicare

Beginning January 1, 2006, upon voluntary enrollment in either a stand-alone PDP or an integrated Medicare Advantage plan that offers Part D coverage in its benefit, subsidized prescription drug coverage. Most FDA-approved drugs and biologicals are covered. However, plans may set up formularies for their drug coverage, subject to certain statutory standards. (Drugs currently covered in Parts A and B remain covered there.) Part D coverage can consist of either standard coverage or an alternative design that provides the same actuarial value. (For an additional premium, plans may also offer supplemental coverage exceeding the value of basic coverage.) Standard Part D coverage is defined for 2006 as having a $250 deductible, with 25 percent coinsurance (or other actuarially equivalent amounts) for drug costs above the deductible and below the initial coverage limit of $2,250. The beneficiary is then responsible for all costs until the $3,600 out-of-pocket limit (which is equivalent to total drug costs of $5,100) is reached. For higher costs, there is catastrophic coverage; it requires enrollees to pay the greater of 5 percent coinsurance or a small copay ($2 for generic or preferred multisource brand and $5 for other drugs). After 2006, these benefit parameters are indexed to the growth in per capita Part D spending (see Table 2.C1). In determining out-of-pocket costs, only those amounts actually paid by the enrollee or another individual (and not reimbursed through insurance) are counted; the exception is cost-sharing assistance from Medicare’s low-income subsidies (certain beneficiaries with low incomes and modest assets will be eligible for certain subsidies that eliminate or reduce their Part D premiums, cost-sharing, or both) and from State Pharmacy Assistance Programs. A beneficiary premium, representing 25.5 percent of the cost of basic coverage on average, is required (except for certain low-income beneficiaries, as previously mentioned, who may pay a reduced or no premium). For PDPs and the drug portion of Medicare Advantage plans, the premium will be determined by a bid process; each plan’s premium will be 25.5 percent of the national weighted average plus or minus the difference between the plan’s bid and the average. To help them gain experience with the Medicare population, plans will be protected by a system of risk corridors, which allow Part D to assist with unexpected costs and to share in unexpected savings; after 2007, the risk corridors became less protective. To encourage employer and union plans to continue prescription drug coverage to Medicare retirees, subsidies to these plans are authorized; the plan must meet or exceed the value of standard Part D coverage, and the subsidy pays 28 percent of the allowable costs associated with enrollee prescription drug costs between a specified cost threshold ($250 in 2006, indexed thereafter) and a specified cost limit ($5,000 in 2006, indexed thereafter).
Source: ssa.gov

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

[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

Medicare Cost Savings Programs

Posted by:  :  Category: Medicare

The SLMB program provides payment of Medicare Part B premiums only for individuals who would be eligible for the QMB program except for excess income. Income for this program must be more than 100% of the FPL, but not exceed 120% or 135% of the FPL.
Source: mo.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

Gym membership & fitness programs

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

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

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

"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

Compare Medicare Supplement Plans 2015Compare Medicare Supplement Plans 2015

With ever increasing numbers of people turning 65 and needing Medicare health care benefits, the choices are numerous. Is a Medicare Supplement plan the best option, or perhaps a Medicare advantage plan? Several people have turned to supplemental insurance for Medicare Part A and Part B and have been extremely happy with their coverage. We’ll help you to compare Medicare Supplement Plans in 2015 so you can choose the best coverage to fit your needs, as well as not overpay for it.
Source: comparemedicaresupplementplans2015.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

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

Indemnity Insurance Definition

Posted by:  :  Category: Medicare

Errors and omissions insurance is commonly sought (and often required) in financial industries, while deferred compensation indemnity insurance has become popular as a way for company executives to protect future money owed to them, even if the company has filed for bankruptcy. Health indemnity insurance is sometimes used when a person is in between health plans, and will cover some (but not all) expenses.
Source: investopedia.com

unicarestateplan.com Home Page

Benefits Information Find a Doctor Check Your Claims Compare Your Costs Avoid Balance Billing Health and Wellness Health Care Quality Initiatives Member Discounts Notification Requirements Request Plan Materials Forms and Documents Email Us
Source: unicarestateplan.com

Summary of Benefits: CIGNA Indemnity Plan

Covered 80% of R&C* after deductible Therapy days, provided as part of an approved Home Health Care Plan, accumulate to the Outpatient Short Term Rehab maximum. If multiple outpatient services are provided on the same day, they constitute one day, but a separate copy will apply to the services provided by each participating provider.
Source: doe.gov

Indemnity Health Insurance Definition

Indemnity health insurance plans typically provide comprehensive medical coverage for a monthly premium. These are called fee-for-service plans, because bills are paid as charges are incurred. Payment is made either to the health care provider or insured person after services are received. Some indemnity plans may require the insured to pay all costs upfront and then file a claim for reimbursement. Other plans may require participants to pay a copayment at the time services are received, such as $20 per office visit. The health care provider then submits a claim for the remaining costs of covered services.
Source: ehow.com

Coventry Medicare: Advantra (HMO/PPO)

Posted by:  :  Category: Medicare

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.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

HealthAmerica/HealthAssurance: Home

For existing members, to obtain the terms of your policy or a copy of your plan document, please contact us at the number located on the back of your member ID card. If you are not an existing member, for additional information on the terms of the policy or a copy of the plan document, click here and choose the appropriate product under the Small Group Certificate of Coverage section.
Source: coventryhealthcare.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

Affordable Arizona Medicare Plans

Posted by:  :  Category: Medicare

insuranceQuotes is an independent, privately-owned company that provides thousands of consumers with an effective and free way to shop and compare insurance quotes online. We are not affiliated with healthcare.gov or other state-based exchanges; however, through trusted partnerships with thousands of insurance agents in your local area and at over a hundred of the nation’s elite insurance providers, consumers using our services can receive quotes for insurance plans that may appear on state-based and/or federal exchanges, as well as for private plans that meet federal standards to be a qualified health plan under the Affordable Care Act. We do not sell health plans ourselves, but work with these licensed entities.
Source: arizonamedicare.org

Need help finding the 2015 Medicare Advantage Part D Plan that best meets your needs?

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

Compare Medicare Supplement Insurance Plans & Medigap Plans and Rates for
2011. See Plan Chart for AL, AR, AZ, CO, FL, GA, IA, ID, KS, KY, LA, MD, MI, MO, MN, MS,
NC, NE, NM, OH, OK, SC, TN, TX, VA & WV. Medigap Insurance Plans including the
Popular Plan F & G

Year after year we have found Medicare Supplement Plan F or Medicare Supplement Plan G to be the best value for the dollar. The new Plan N is a great alternative to a Medicare Advantage plan.  Plan N might be recommended depending on which state you live in and how much the supplement cost in relation to available Medicare Advantage plans. A plan N will provide more coverage and a very reasonable premium. In Florida we have the lowest rate for plan F & plan N. See the Medicare Supplement Plan chart below. In general, the higher you go up in the plan chart the more Gaps the plan fills. Medicare Supplement Plan F is the most comprehensive supplement plan and there is not a better plan than F. Most people will select a Plan F. However, depending on your personal situation there may be a more cost efficient choice.
Source: themedicarechannel.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

About the Blue Cross and Blue Shield Association

Posted by:  :  Category: Medicare

Blue Cross Blue Shield Association and Blue Health Intelligence have collaborated and released the Blue Cross Blue Shield, The Health of America Report. This report analyzed three years of independent Blue Cross and Blue Shield (BCBS) companies’ claims data for typical knee and hip replacement surgeries and found that their cost can vary by as much as 313%, depending on where the surgeries are performed. Read the full report.
Source: bcbs.com

BCBS Medicare Supplement Insurance Plans

Your state officials control which Medigap plans are available in your state, but you can see the benefits of all 10 forms of Medigap insurance by clicking here. And, our instant quotes will show you a selection of Medigap plans for your state offered by leading insurance companies that have been prescreened for financial soundness. We rely on A.M. Best, an independent financial rating organization, and represent insurers with some of the highest ratings.
Source: medigapadvisors.com

National Doctor and Hospital Finder

You can narrow your search by choosing from a range of criteria when you see your results, such as gender, accepting new patients, hospital affiliation. (The criteria vary depending on whether you’re searching for doctors, clinics, hospitals or other providers.)
Source: bcbs.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.gov Nursing Home Compare

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

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

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

The 25 health systems with highest ratio of unfunded pension liabilities, ranked by the organization’s ratio of unfunded pension liabilities in 2014. Source: Modern Healthcare reporting on largest 50 health systems by total assets. Published Sept. 28, 2015, p. 38.
Source: modernhealthcare.com

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

Medicare Timely Filing Denials: How to Avoid Rejection

5 Must-track Metrics 52 Things Healthcare Learned in 2012 52 Things Healthcare Learned in 2013 A/R Best Practices accounts receivables actionable analytics Bizarre ICD-10 codes Carecloud awards claim denials claims tracking cloud-based EHR Cloud Computing Report consumer-driven healthcare EHR EHR Buying Guide End of EMR health IT ICD-10 ICD-10 codes kpi medical billing medical billing software medical group finances MGMA modifier 59 neurology ICD-10 new patients orthopedic surgeons orthopedic surgery orthopedic surgery practice orthopedic surgery software other technologies outsource medical billing outsourcing patient engagement patient no-shows patient portal Power 5 Week In Review practice management practice management software rcm revenue cycle revenue cycle management Time for a Switch x codes
Source: poweryourpractice.com

CMS Delivers Additional Information Regarding Medicare Timely Filing Rule

*Change request (CR) 6960 specified the basic timely filing standards established for FFS reimbursement, which are a result of Section 6404 of the Patient Protection and Affordable Care Act of 2010 (ACA) that states that claims with dates of service on or after January 1, 2010, received later than one calendar year beyond the date of service will be denied by Medicare.
Source: managemypractice.com

Publication 334 (2014), Tax Guide for Small Business

If you make or receive payments in your business, you may have to report them to the IRS on information returns. The IRS compares the payments shown on the information returns with each person’s income tax return to see if the payments were included in income. You must give a copy of each information return you are required to file to the recipient or payer. In addition to the forms described below, you may have to use other returns to report certain kinds of payments or transactions. For more details on information returns and when you have to file them, see the General Instructions for Certain Information Returns.
Source: irs.gov

Medicare.gov Physician Compare Home Page

Posted by:  :  Category: Medicare

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Source: medicare.gov

How Medicare Paperwork Abuses Doctors and Harms Patients

It is my pleasure to welcome you to the first in a series of Heritage programs assessing how the Medicare program is serving Medicare patients today and how well it is prepared to face the serious challenges offered by 77 million baby boomers tomorrow. Beyond its financial problem, the Medicare program has many more problems. These are rooted in a little-understood aspect of the program–the huge regulatory morass that governs Medicare. The prestigious Mayo Foundation has estimated that the number of pages of federal regulations and related paperwork that doctors and hospitals must comply with in order to treat Medicare and Medicaid patients totals more than 132,000 pages–almost 111,000 of which govern Medicare alone. This is roughly six times the size of the impossibly complex Internal Revenue Service code and its federal tax regulations.
Source: heritage.org

Find & compare doctors, hospitals, & other providers

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

Doctors and Medicare Payment, Reimbursement, and Excess Charges

Three times a year, a special committee of doctors meets to discuss recommendations on updates to how much doctors should be paid for their work and other relative values. The committee, also known as the Relative Value Scale Update Committee (RUC), is made up of individuals convened by the American Medical Association (AMA) and other medical-specialty trade groups. Around 90% of the recommendations by the RUC are followed by the Center for Medicare and Medicaid Services (CMS), allowing the committee great influence over the billions of taxpayer dollars in the Medicare program.
Source: planprescriber.com

Medicare Unmasked: Behind the Numbers

This project uses data made public by the Centers for Medicare and Medicaid Services. It shows the dollar amounts that doctors and other medical providers received in Medicare reimbursements in 2012 and 2013, along with other data including their specialties. Only procedures which providers performed on more than 10 Medicare patients were included in the data released. There is some information CMS hasn’t provided. In some cases, procedures attributed to a specific physician may have been performed by other people under that doctor’s supervision. The data doesn’t include information on patients nor does it show doctors’ billings related to durable medical equipment.
Source: wsj.com

Coventry Medicare: Doctors & Hospitals

Coventry’s provider search function below is updated regularly and is based on the particular plan you are selecting.  When you enroll in a Coventry Medicare Advantage plan, it is important to know that services are provided through the plan’s delivery system.  Coventry Health Care regularly seeks to broaden the scope of our provider network with additional physicians and hospitals for our Medicare Advantage plans.  However, the availability or continued participation of any one doctor, hospital, or other provider cannot be guaranteed.
Source: coventryhealthcare.com

Government Report Cites Shortfalls in Medicare’s Screening Process for Doctors

Thousands of medical providers signed up to bill Medicare using questionable addresses, and dozens of doctors enrolled despite disciplinary actions by state medical boards, according to a congressional probe of the $600 billion-a-year taxpayer-funded program.
Source: wsj.com