Coventry Medicare: First Health Part D

Posted by:  :  Category: Medicare

First Health Part D (Legal Disclaimers) First Health Part D is a Medicare-approved Part D sponsor. Enrollment in our plan(s) depends on contract renewal. Other pharmacies are available in our network. 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. Cost sharing for members who get “Extra Help” is the same at preferred and network pharmacies. This information is available for free in other languages. Please call our customer service number at 1-866-865-0662 (TTY 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.
Source: coventryhealthcare.com

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

Coventry Medicare: Formulary (Drug List)

A formulary is a list of prescription medications that are covered by your plan and are available in a booklet format and an online searchable tool.  A pharmacy directory is a listing of pharmacies in your plan’s network, including retail chain pharmacies, preferred and non-preferred mail-order pharmacies, home infusion and long-term care pharmacies. 
Source: coventryhealthcare.com

Medicare Eligibility and Enrollment

Posted by:  :  Category: Medicare

re already getting Social Security checks, you will be automatically enrolled in traditional Medicare. You’ll get your Medicare card three months before your 65th birthday. The benefits kick in on the first day of the month of your 65th birthday. Traditional Medicare, which is also called original Medicare, includes Medicare Parts A and B. Part A is hospital coverage. Part B covers doctor visits, lab tests, and other outpatient services.
Source: webmd.com

Who is Eligible for Medicare?

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

Who is eligible for Medicare Part B coverage?

The rules of eligibility for Part B medical insurance are simpler than for Part A: If you are age 65 or over and are either a U.S. citizen or a permanent resident who has been here lawfully for five consecutive years, you are eligible to enroll in Medicare Part B medical insurance. This is true whether or not you are eligible for Part A hospital insurance.
Source: nolo.com

Medicare Eligibility Rules

If you are age 65 and currently receiving Social Security or Railroad Retirement Benefits, you are eligible for Medicare and you will be automatically enrolled in Medicare Part A and Part B. However, because Part B has a premium, you have the option of declining Part B coverage. In addition, Part B does require payment of a monthly premium of $104.90, barring certain exceptions, for individuals enrolling in Part B January 1, 2015 or later. These premiums can change on an annual basis.
Source: planprescriber.com

Medicare Eligibility Requirements

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

Compare Medicare Advantage & Supplemental Plans

Posted by:  :  Category: Medicare

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

Find and Compare Best Medicare Plans Online

The Original Medicare Plan, or Part A and Part B coverage, is a federally managed fee-for-service plan. Beneficiaries can choose the doctor and hospital from which they would like to receive services. Monthly premiums, annual deductibles and co-payments for services are required. Prescription drug coverage, or Medicare Part D, may be added to the Original Medicare Plan. Many beneficiaries covered by the Original Medicare Plan find they also need the Medigap policy to help pay for services not covered by Part A and Part B. Medicare Advantage Plans (Part C) provides Part A and Part B coverage, but this coverage is provided by private insurance companies that have been approved by Medicare. Because private companies provide this coverage, additional benefits may be available. Additionally, the amounts charged for various services may differ between providers. Part C plans may have networks, and the beneficiary will have to utilize the services of providers in the plan’s network. Prescription drug coverage is often included in this plan. Beneficiaries of Medicare Part C do not need to purchase Medigap coverage. When choosing a plan it is important to determine what is expected from the insurance coverage. It would be advantageous for beneficiaries to compare and select coverage based on the plan that will best meet their individual needs.
Source: online-health-insurance.com

America’s Health Insurance Plans

Medigap plans are used by nearly 10 million seniors and other Medicare beneficiaries, offering them a sense of security about both the predictable and unexpected costs associated with medical care.Analyses of federal data show that Medigap is a particularly important coverage option for low-income and rural seniors. Surveys consistently find that Medigap beneficiaries are highly satisfied with their Medigap coverage. To get involved in advocating for Medigap, please visit: www.partnershiptoprotectmedigap.org.
Source: ahip.org

Best Medicare Supplement Insurance Quotes

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

Overview of Medicare Supplemental Insurance

Medicare has several gaps and doesn’t pay for all of the health care services you may need. If you are in the Original Medicare Plan, you may want to buy Medicare supplemental insurance, also called Medigap insurance. This is health insurance that helps pay for some of your costs in the Original Medicare program and for some care it doesn’t cover.   Medigap insurance is sold by private insurance companies. By law, companies can only offer standard Medigap insurance plans. There are 11 standard plans labeled A-N. Each plan, offers a different set of benefits, fills different “gaps” in Medicare coverage, and varies in price. You will want to study all the Medigap plans before deciding which is best for you. No matter which insurance company offers a particular plan, all plans with the same letter cover the same benefits. For instance, all Plan C policies have the same benefits no matter which company sells the plan. However, the premiums can vary. All 11 standard Medigap policies cover basic benefits, but each has additional benefits that vary according to the plan. None of the standard Medigap plans cover: • long-term care to help you bathe, dress, eat or use the bathroom • vision or dental care • hearing aids • eyeglasses • private-duty nursing • prescription drugs If you live in Massachusetts, Minnesota or Wisconsin, you have different standard Medigap plans.   In addition to the standard Medigap policies, Medicare SELECT is a type of Medigap policy that can cost less than standard Medigap plans. However, you can only go to certain doctors and hospitals for your care.  Check with your state insurance department to find out if Medicare SELECT policies are available in your state. Medigap Basic Benefits    All plans must offer these basic benefits. The basic benefits for plans K – L include similar services as plans A-G and M but the cost-sharing for the basic benefits is at different levels. Medicare Part A After you have paid your hospital deductible ($1,100 in 2010), the Original Medicare Plan pays all your hospital costs for up to 60 days in a benefit period*. If you stay in the hospital more then 60 days, you pay $275 (in 2010) a day for days 61 through 90.  If you stay longer than 90 days in a benefit period, the cost for each day is $550 (in 2010) for up to 60 days over your lifetime.   All 11 Medigap plans cover (pay) your costs for days 61 through 150.  In addition, once you use your 150 days of Medicare hospital benefits, all Medigap plans cover the cost of 365 more hospital days in your lifetime. If you have the high-deductible option of plan F, you must first pay $2,000 in health care expenses before your costs will be covered. If you have plans K, L or M you will have to pay a portion of the hospital deductible ($1,100 in 2010), before your costs will be covered (unless you have already met the annual out-or-pocket maximum for the year. *A benefit period begins the day you go to the hospital and ends when you have been out of the hospital for 60 days in a row. If you go into the hospital again after 60 days have passed, you begin a new benefit period. Medicare Part B After you pay your yearly Part B deductible ($155 in 2010), Medicare generally pays 80 percent of doctor and other medical services. It pays 50 percent of mental health services and 100% of some preventive services. Medigap plans cover all or part of your share of these services – 20 percent of the Medicare-approved amount for doctor services and 50 percent for mental health services.  (The Medicare approved amount is the amount that Medicare decides is a reasonable payment for a medical service). Blood The Original Medicare Plan doesn’t cover the first three pints of blood you need each year. Plans A-D, F-G, and M through N pay for these first three pints. Plans K pays 50% and L pays 75% part of the cost. Preventive Care All 11 Medigap plans offer this benefit, which covers any coinsurance for Part B preventive services. Hospice Medigap covers the 5 % coinsurance for palliative drugs and respite care under the Part A hospice benefit. Medigap Additional Benefits Medicare Part A Hospital Deductible Medigap Plans B, C, D, F, G and N cover the hospital deductible ($1,100 in 2010) for each benefit period. Plans K, L, and M cover part of it. This benefit usually saves you money if you have to stay in the hospital.   Skilled Nursing Home Costs The Original Medicare Plan pays all of your skilled nursing home costs for the first 20 days of each benefit period. If you are in a nursing home for more than 20 days, you pay part of each day’s bill.   Medigap Plans C, D, F, G and M through N pay your share of the bill ($137.50 a day in 2010) for days 21 through 100. Plans K and L pay part of it. Neither Medicare nor any Medigap plan pays for any skilled nursing home stay longer than 100 days in a benefit period. Medicare Part B Deductible You must pay a deductible each year for doctor and other medical services before Medicare pays.   Medigap Plans C and F pay this deductible. In 2010, the deductible is $155.
Source: aarp.org

Medicare Supplemental Insurance — Which policy is best?

Our recommendation: After picking the benefit combination (Plan A through L) that best suits your needs, buy the issue-age or community-rated Medigap policy with the lowest premium. Even though they are a bit more expensive at the start, your premiums won’t go up every year just because you get older. (AARP’s Medigap plans use a combination of issue-age and community-rated methods; their premiums don’t increase as you get older, but their younger retirees do receive a discount.)
Source: todaysseniors.com

Medicare Supplemental Health Insurance Plans

"My experience with MediGap Advisors has been excellent primarily due to the efforts of my agent, Jim Kinert. Jim spends considerable time with me in order to provide the single best coverage I could have ever hoped for. He is an exceptional representative of your organization, far surpassing my expectations by making the entire process easy to understand and easy to actuate. Rarely have I dealt with a salesperson that has made me feel that he had my best interests at heart. I have never particularly enjoyed the prospect of obtaining insurance of any kind, but Jim’s approach gave me a great sense of confidence that I was doing business with the right man and the right company. Jim’s winning personality, in-depth knowledge, and lack of high pressure sales tactics convinced me to do business with you."
Source: medigapadvisors.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.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

What is Medicare? What is Medicaid?

Medicare Part A, or Hospital Insurance (HI), helps pay for hospital stays, which includes meals, supplies, testing, and a semi-private room. This part also pays for home health care such as physical, occupational, and speech therapy that is provided on a part-time basis and deemed medically necessary. Care in a skilled nursing facility as well as certain medical equipment for the aged and disabled such as walkers and wheelchairs are also covered by Part A. Part A is generally available without having to pay a monthly premium since payroll taxes are used to cover these costs.
Source: medicalnewstoday.com

Medicare Part D coverage gap

Posted by:  :  Category: Medicare

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 Coverage

Part D is prescription drug coverage insurance that is provided by private companies approved by Medicare. You need to enroll when you first become eligible to keep from paying a penalty cost later. Part D was designed to help people with Medicare to lower their prescription drug costs and to protect against future costs. A prescription drug plan will also enable you to have greater access to medically necessary drugs.
Source: medicareconsumerguide.com

Understanding the Medicare Part D Donut Hole

Once you and your Part D drug plan have spent $2,840 for covered drugs, you will be in the donut hole. Previously, you had to pay the full cost of your prescription drugs while in the donut hole. However, in 2011, you get a 50% discount on covered brand-name prescription medications. The donut hole continues until your total out-of-pocket cost reaches $4,550. This annual out-of-pocket spending amount includes your yearly deductible, copayment, and coinsurance amounts.
Source: about.com

Drug Finder: Find which 2015 Medicare Part D plans best covers your drugs

- Copay / Coinsurance – 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. The drug Tier is shown to the left of this column. 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. There are two figures shown under this “Cost Sharing” category:
Source: q1medicare.com

The United States Social Security Administration

Posted by:  :  Category: Medicare

Today, the Social Security Administration proudly celebrates its 80th anniversary. On August 14, 1935, President Franklin D. Roosevelt signed the Social Security Act, landmark legislation that continues to provide hope…
Source: ssa.gov

New Social Security home page

The Social Security home page, www.socialsecurity.gov, has a whole new look. One, I’ve been told, designed to present a fresh, modern look and feel, reflecting current trends and best practices in web design. Included are a new top banner and
Source: areavoices.com

Social Security Administration Upgrades Website

Apply for Benefits Online One of the most popular Internet services offered by SSA is the online benefits application, where visitors can apply for retirement, spouse’s and disability benefits via the Internet. This service — found at www.socialsecurity.gov/applyforbenefits — allows people to conduct business with SSA at a time that is convenient to them and from the comfort of their own home.
Source: about.com

Social Security Administration

For some claimants, this program is harder to receive than funds from RSDI. To warrant a processing time of anything more than a day and an immediate denial, certain specific criteria must be met, including citizenship status, having less than $2,000.00 in countable financial resources, or having countable income of less than $718.00 per month from any source. Disposal of a financial resource (i.e., a deliberate spend-down to fall under SSI resource ceilings) can prevent a person from receiving SSI benefits for a period up to 36 months. Every person with or without a Social Security Number is eligible to apply. But if a person does not meet any of the above criteria or is not a documented resident of the United States, his or her claim can only be taken on paper and will be immediately denied. Even documented residents with legal permanent resident status after August 1996 are immediately denied unless they meet some or all of the SSI criteria listed above.
Source: wikipedia.org

Medicare Changes For 2015

Posted by:  :  Category: Medicare

Deductible Increase–Drug deductibles will increase in 2015 AARP reports, “The maximum Part D annual drug deductible rises by $10, to $320, in 2014. More plans will charge a deductible (from $1 to $320) and fewer will wave the deductible.” There is an expected rise of 4 percent—while that does not sound huge, that is the expected average. Kaiser Family Foundation notes that number “masks a significant amount of variation across plans…enrollees in six of the 10 most popular [stand-alone plans] will experience double-digit premium increases if they stay in the same plans in 2015, while enrollees in three of the 10 most popular [stand-alone plans] will see double-digit premium decreases”
Source: nasdaq.com

Office of Legislation and Congressional Affairs

Effective January 1, 2006, a new Medicare Prescription Drug Program, also referred to as Medicare Part D, was launched. In addition to the prescription drug insurance the program makes available to all Medicare beneficiaries, the program also provides subsidies – or “extra help”– for those Medicare beneficiaries who have limited income and resources. These subsidies reduce out of pocket costs paid by those Prescription Drug Program (PDP) enrollees who have limited income (below 150% of the poverty line applicable to the size of the family involved) and resources (up to $12,677 in assets for an individual or $25,260 for a married couple in 2011) by providing reduced monthly premiums and other cost-sharing assistance.
Source: ssa.gov

Sweeping Changes to Medicare Payment for Clinical Laboratory Services

The Act also updates the processes by which new laboratory tests are coded by Medicare.  CMS is now required to adopt temporary HCPCS codes to identify new “advanced diagnostic laboratory tests” and new tests that are cleared or approved by the Food and Drug Administration (FDA).  These temporary codes will be effective for a period of up to two years pending the adoption of a permanent HCPCS  or Current Procedural Terminology (CPT).(CPT is a registered trademark of the American Medical Association.)code.  In addition, by 2016, all advanced diagnostic laboratory tests and tests cleared or approved by the FDA, which are currently paid under the CLFS without unique codes, will be assigned unique HCPCS codes.  This should reduce coverage and payment uncertainties associated with the current practice of using non-specific or not-otherwise-classified codes.  The requirement for specific temporary coding should assist laboratories and manufacturers to commercialize new tests for which uncertainty or delay in obtaining test-specific codes has currently hindered market adoption.
Source: mwe.com

Medicare Advantage 2015 Data Spotlight: Overview of Plan Changes

When SNPs were authorized, there were few requirements beyond those otherwise required of other Medicare Advantage plans. The Medicare Improvements for Patients and Providers Act (MIPPA) of 2008 established additional requirements for SNPs, including requiring all SNPs to provide a care management plan to document how care would be provided for enrollees and requiring C-SNPs to limit enrollment to beneficiaries with specific diagnoses or conditions. As a result of the new MIPPA requirements, the number of SNPs declined in 2010. The ACA required D-SNPs to have a contract with the Medicaid agency for every state in which the plan operates, beginning in 2013. Additionally, in 2013, joint federal-state financial alignment demonstrations to improve the coordination of Medicare and Medicaid for dually eligible beneficiaries began to enroll beneficiaries. Today, financial alignment demonstrations are underway in 12 states: California, Colorado, Illinois, Massachusetts, Michigan, Minnesota, New York, Ohio, South Carolina, Texas, Virginia, and Washington. The financial alignment demonstrations could influence the availability of D-SNPs in these states, either increasing or decreasing the availability of SNPs, depending on the design of the demonstration.
Source: kff.org

Health Care Innovation Awards Round Two

AZ*/initiatives/Health-Care-Innovation-Awards-Round-Two/Arizona.html^CA*/initiatives/Health-Care-Innovation-Awards-Round-Two/California.html^CO*/initiatives/Health-Care-Innovation-Awards-Round-Two/Colorado.html^CT*/initiatives/Health-Care-Innovation-Awards-Round-Two/Connecticut.html^DC*/initiatives/Health-Care-Innovation-Awards-Round-Two/Washington-DC.html^FL*/initiatives/Health-Care-Innovation-Awards-Round-Two/Florida.html^GA*/initiatives/Health-Care-Innovation-Awards-Round-Two/Georgia.html^IL*/initiatives/Health-Care-Innovation-Awards-Round-Two/Illinois.html^IA*/initiatives/Health-Care-Innovation-Awards-Round-Two/Iowa.html^KS*/initiatives/Health-Care-Innovation-Awards-Round-Two/Kansas.html^MD*/initiatives/Health-Care-Innovation-Awards-Round-Two/Maryland.html^MA*/initiatives/Health-Care-Innovation-Awards-Round-Two/Massachusetts.html^MI*/initiatives/Health-Care-Innovation-Awards-Round-Two/Michigan.html^MN*/initiatives/Health-Care-Innovation-Awards-Round-Two/Minnesota.html^MO*/initiatives/Health-Care-Innovation-Awards-Round-Two/Missouri.html^NE*/initiatives/Health-Care-Innovation-Awards-Round-Two/Nebraska.html^NH*/initiatives/Health-Care-Innovation-Awards-Round-Two/New-Hampshire.html^NM*/initiatives/Health-Care-Innovation-Awards-Round-Two/New-Mexico.html^NY*/initiatives/Health-Care-Innovation-Awards-Round-Two/New-York.html^NC*/initiatives/Health-Care-Innovation-Awards-Round-Two/North-Carolina.html^OH*/initiatives/Health-Care-Innovation-Awards-Round-Two/Ohio.html^OR*/initiatives/Health-Care-Innovation-Awards-Round-Two/Oregon.html^PA*/initiatives/Health-Care-Innovation-Awards-Round-Two/Pennsylvania.html^SD*/initiatives/Health-Care-Innovation-Awards-Round-Two/South-Dakota.html^TX*/initiatives/Health-Care-Innovation-Awards-Round-Two/Texas.html^VA*/initiatives/Health-Care-Innovation-Awards-Round-Two/Virginia.html^WA*/initiatives/Health-Care-Innovation-Awards-Round-Two/Washington.html^WI*/initiatives/Health-Care-Innovation-Awards-Round-Two/Wisconsin.html^
Source: cms.gov

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

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

Costs for Medicare drug coverage

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

2015 Wisconsin 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

2015 Medicare Drug Formulary

A comprehensive formulary is an entire list of Part D drugs covered by a Part D plan. The drugs on the list are selected by HealthPartners in consultation with a team of health care providers believed to be a necessary part of a quality treatment program. It outlines the drugs that HealthPartners will cover for its Medicare plan members as long as the drug is medically necessary, filled at a HealthPartners network pharmacy and all other plan rules are followed. Please see the Drug Management Programs section of the Evidence of Coverage for information about our quality assurance policies and procedures, including Medication Therapy Management and drug utilization. Generally, the formulary does not change during the year. There are some exceptions. For details, please see page I-3 of the printable formulary. If your drug is not on our formulary, you can request a coverage decision or exception by completing the Coverage Determination Form.
Source: healthpartners.com

Medicare Prescription Drug Plans

Care Improvement Plus may add or remove drugs from the formulary during the year. If we remove drugs from our formulary, add prior authorization(s), quantity limits and/or step therapy restriction(s) on a drug, and/or move a drug to a higher cost-sharing tier, we will notify you of the change at least 60 days before the date that the change becomes effective. However, if the Food and Drug Administration (FDA) deems a drug on our formulary to be unsafe or the drug’s manufacturer removes the drug from the market, in which case we will immediately remove the drug from our formulary and notify you of the change.
Source: careimprovementplus.com

Medicare Drug List – Drug Formulary

Below are the lists of covered drugs in our Cigna-HealthSpring Medicare Advantage and Rx plans. If your drug appears on the drug list, then it is a covered drug under that plan. However, there may be certain requirements, such as prior authorization or quantity limits that need to be fulfilled as part of your prescription drug coverage. If you have questions, please visit our Drug List Frequently Asked Questions (FAQ) page.
Source: cigna.com

Part D Drug Formulary 2015

Generally, if you are taking a drug that was covered at the beginning of the year, we will not discontinue or reduce coverage of the drug during the coverage year except when we receive information from the FDA that a drug is no longer safe or effective. Complete information about these changes is included in the formulary documents above. Group Health Medicare Advantage plans cover both brand name drugs and generic drugs. Generic drugs have the same active-ingredient formula as a brand name drug. Generic drugs usually cost less than brand name drugs and are rated by the Food and Drug Administration (FDA) to be as safe and effective as brand name drugs.
Source: ghc.org

Physicians for a National Health Program

Posted by:  :  Category: Medicare

The Affordable Care Act will add more than a quarter of a trillion dollars to the already very high administrative costs of U.S. health care through 2022, according to a study published Wednesday at the Health Affairs Blog.
Source: pnhp.org

Dean Clinic, Dean Health Plan, Dean Foundation

Online Member Guide Premium Payments Member Benefits Document Center Pharmacy Services & Programs State Employee Members Medicare Members BadgerCare Plus Members Living Healthy Program All Member Resources
Source: deancare.com

UPMC: #1 Ranked Hospital in Pittsburgh and Pennsylvania

September is World Alzheimer’s Month™. Alzheimer’s is a disease of the brain caused by chemical changes that kill brain cells. It usually occurs in people over the age of 65 and is the leading cause of dementia. As this condition progresses, it causes the gradual loss of one’s ability to think, remember, and perform daily tasks.
Source: upmc.com