Medicare Part B Medical Insurance: Coverage, Premiums, Coinsurance & Deductibles

Posted by:  :  Category: Medicare

The Medicare Part B premium ($104.90 in 2015) is automatically deducted from your Social Security check every month. If you don’t receive Social Security benefits, you will be billed for Part B. People with higher incomes (individuals with annual incomes over $85,000 and couples with incomes over $170,000) will pay higher Part B premiums. See table below.
Source: cahealthadvocates.org

Are Medicare Premiums Tax Deductible?

Medicare beneficiaries normally pay their premiums through withholding by the Social Security Administration. If you’re retired, for example, your premiums will come out of your monthly benefits. Social Security keeps track of these payments and will issue a form 1099-SSA in January to itemize the amount of your Medicare premiums over the last year. If you’re self-employed, and filing a Schedule C for your business, premiums you pay for health insurance are deductible as an "above the line" write-off on Line 29 of Form 1040.
Source: ehow.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 Information, Help, and Plan Enrollment

Humana is a Medicare Advantage [HMO, PPO and PFFS] organization with a Medicare contract. Enrollment in any Humana plan depends on contract renewal. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments and restrictions may apply. Benefits, premiums and/or member cost-share may change on January 1 of each year.
Source: medicare.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 Open Enrollment 2016

Posted by:  :  Category: Medicare

In accordance with section 1853(b)(1) of the Social Security Act (the Act), we are notifying you of the annual Medicare Advantage (MA) capitation rate for each MA payment area for CY 2014 and the risk and other factors to be used in adjusting such rates. The capitation rate tables for 2013 are posted on the Centers for Medicare & Medicaid Services (CMS) web site at http://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/index.html under Ratebooks and Supporting Data. The statutory component of the regional benchmarks, transitional phase-in periods for the Affordable Care Act rates, qualifying counties, and each county’s applicable percentage are also posted at this website.
Source: medicarehealthinsurancefacts.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

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

What’s Medicare Supplement Insurance (Medigap)?

Some Medigap policies also offer coverage for services that Original Medicare doesn’t cover, like medical care when you travel outside the U.S. If you have Original Medicare and you buy a Medigap policy, Medicare will pay its share of the Medicare-approved amount for covered health care costs. Then your Medigap policy pays its share.
Source: medicare.gov

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

Medicare Supplement Insurance and Plans

Medicare is the federal program the vast majority of Americans 65 and older depend on for their healthcare. People under 65 with disabilities and individuals with end-stage renal disease can also qualify. Medicare is commonly divided into four parts. Original Medicare Part A and Part B help pay costs for hospital care and medical expenses, respectively. Specifically, Part A pays for medically-necessary inpatient hospital services, skilled nursing facility care after a hospital stay, certain home healthcare, and hospice care. Part A does not pay for private hospital rooms, surgery that is not deemed medically-necessary, most care received outside the United States, unskilled personal care, and a variety of other services. Part B, meanwhile, pays only 80% of most Medicare-covered medical costs. Deductible, copayment, and coinsurance costs associated with Original Medicare add up quickly for many people.
Source: medicaremall.com

How to compare Medigap policies

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 Supplement Insurance

The Part A hospital deductible – you’re responsible for paying a deductible if you are admitted into the hospital. In 2014 this deductible is $1184. Many people think that this is a one time or a annual deductible and it is not. This deductible is based on benefit periods of 60 days. This means if you are admitted to the hospital and then released and you stay out of the hospital for 60 days or more, that is considered one benefit period. If you are admitted again after that 60 day period you must pay this deductible again.
Source: medisupps.com

Medicare.gov: the official U.S. government site for Medicare

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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

2016 Tennessee Medicare Part D Prescription Drug Plan Highlights www.Q1Medicare.com

Posted by:  :  Category: Medicare

Coverage Gap the Donut Hole: In the CMS Standard Plan, the beneficiary must pay the next $3752.5 in drug costs (the Donut Hole). The Healthcare Reform provides that for Plan Year 2016, ALL formulary generics will have at least a 42% 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

Tennessee Medicare Assistance

Both programs work hand in hand to assist all Tennesseans with their questions and concerns about Medicare issues. Working through federally funded grants from Centers for Medicare and Medicaid Services and Administration on Aging, SHIP and SMP is administered throughout the nine Area Agencies on Aging and Disability.
Source: tnmedicarehelp.com

Tennessee Nursing Home Guide; Tennessee Medicare Extended Care, Rehab

The Division of Health Care Facilities is responsible for ensuring quality of care in hospitals, nursing homes, ambulatory surgical treatment centers, and other kinds of health care facilities in Tennessee. The division licenses and/or certifies 21 types of health care facilities, including laboratories. The Division also conducts state licensure and/or federal certification surveys annually for participation in the Medicare and Medicaid programs, and is responsible for the investigation of all facility complaints received, and the issuance and collection of state and /or federal civil monetary penalties. Facility surveys and complaint investigations are coordinated and conducted from our three regional offices located in Jackson, Nashville, and Knoxville.
Source: dibbern.com

Medicare Supplement Insurance Plans

Hi, my name is Philip Edwards, and I would like to help you to sort through the confusing maze of Medicare choices to get the best health care in your retirement years, while at the same time risking as little as possible of your financial assets.  I regularly look at the Medicare choices available in your area for prescription drug coverage through Part D Medicare plans, as well as both Medicare Advantage plans and the more traditional Medicare Supplemental plans.  When I sit down with you I want you to understand how these Medicare plans work, so you can see which is the best choice for you individually.  These Medicare plans vary not only by state but by county, so your friends or relatives plan may or may not be the best for you.  This is my specialty, so please let me simplify the Medicare choices for you. 
Source: seniorinsurancesolutions.org

Medical Billing and Coding

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Medical Billing Solution, Medical Billing Training Program, About Outsourcing Services, Medical Billing Process and Concept, Tips to Medical Biller, Specialist. Medical Insurance Billing Denial Guidelines. Medical Billing Training Articles and Software Review. Medicare Billing CPT code ,ICD-9 DX Code Update.
Source: whatismedicalinsurancebilling.org

Medicare Billing for Well Woman Exam

1. Cervical High Risk Factors a. Early onset of sexual activity (under 16 years of age) b. Multiple sexual partners (five or more in a lifetime) c. History of a sexually transmitted disease (including HIV infection) d. Fewer than three negative pap smears within the previous 7 years 2. Vaginal Cancer High Risk Factors: DES (diethylstilbestrol) exposed daughters of women who took DES during pregnancy 3. Personal History of Health Hazards: If a patient has a specified personal history presenting hazards to health then apply the V15.89 diagnosis and the appropriate health history hazard (example: V10.3 History of Breast Malignancy).  Any V15.89 diagnosis is considered high risk and makes the patient eligible for the yearly G0101 and Q0091.
Source: capturebilling.com

Electronic Billing & EDI Transactions

The information in this section is intended for the use of health care providers, clearinghouses and billing services that submit transactions to or receive transactions from Medicare fee-for-service contractors. EDI is the automated transfer of data in a specific format following specific data content rules between a health care provider and Medicare, or between Medicare and another health care plan. In some cases, that transfer may take place with the assistance of a clearinghouse or billing service that represents a provider of health care or another payer. EDI transactions are transferred via computer either to or from Medicare. Through use of EDI, both Medicare and health care providers can process transactions faster and at a lower cost. Please see pages on specific types of EDI conducted by Medicare for related links and downloads as applicable.
Source: cms.gov

DMEPOS Competitive Bidding

Posted by:  :  Category: Medicare

Under the program, a competition among suppliers who operate in a particular competitive bidding area is conducted. Suppliers are required to submit a bid for selected products. Not all products or items are subject to competitive bidding. Bids are submitted electronically through a web-based application process and required documents are mailed. Bids are evaluated based on the supplier’s eligibility, its financial stability and the bid price. Contracts are awarded to the Medicare suppliers who offer the best price and meet applicable quality and financial standards. Contract suppliers must agree to accept assignment on all claims for bid items and will be paid the bid price amount. The amount is derived from the median of all winning bids for an item.
Source: cms.gov

Medicare National Competitive Bidding Program

CCS Medical is one of only 18 suppliers awarded CMS contracts to provide mail order diabetic testing supplies at competitively bid prices nationwide and in the four U.S. territories (American Samoa, Guam, Puerto Rico, and the U.S. Virgin Islands). As announced previously by CCS Medical, one of the brands that CCS Medical will be carrying is LifeScan’s OneTouch® Ultra® test strips, the No. 1 brand recommended by endocrinologists and diabetes educators.
Source: ccsmed.com

Medicare Expands Competitive Bidding Program for Durable Medical Equip…

You can also get the supplies from a store or pharmacy that accepts "Medicare assignment." This means that the store will accept the Medicare-approved amount as payment in full and that you cannot be charged more than a 20 percent copay (after you meet your annual deductible). A Medicare contract supplier can’t charge you more than that for the equipment or supplies included in the competitive bidding program.
Source: aarp.org

Competitive Bidding Program

The Competitive Bidding Program replaces the outdated prices Medicare has been paying with lower, more accurate prices. Under this program, suppliers submit bids to provide certain medical equipment and supplies at a lower price than what Medicare now pays for these items. Medicare uses these bids to set the amount it pays for those equipment and supplies under the Competitive Bidding Program. Qualified, accredited suppliers with winning bids are chosen as Medicare contract suppliers.
Source: medicare.gov

Medicare Eligibility Rules

Posted by:  :  Category: Medicare

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 Coding Rules for SLP Services

Untimed CPT codes represent “typical” visit lengths or times to conduct a typical test unless the time is specified in the CPT descriptor. For significantly atypical procedures, a “-22″modifier can be used to indicate that the work is substantially greater than typically required and a “-52″modifier for an abbreviated procedure. Modifier “-22″ should not be used frequently because the Medicare contractor could make the determination that the procedure reflects typical service delivery. For claims with the “-22″ modifier a description of the need for extended services should accompany the claim. Modifier “-59″ is used to establish one procedure as distinct from another procedure billed on the same day. Part B services provided under plans of care for speech-language pathology or dysphagia services require a GN modifier as a suffix to the CPT code. The requirement applies to physician offices as well as facilities and private practices. Occupational therapy and physical therapy modifiers are GO and GP, respectively. For therapy services that exceed the annual therapy cap, a -KX modifier is required, indicating services are medically necessary and the documentation is available for review.
Source: asha.org

Medicare CPT Coding Rules for Audiology Services

Untimed CPT codes represent “typical” visit lengths or times to conduct a typical test unless the time is specified in the CPT descriptor. For significantly atypical procedures, a “-22″modifier can be used to indicate that the work is substantially greater than typically required and a “-52″modifier for an abbreviated procedure. Modifier “-22″ should not be used frequently because the Medicare contractor could make the determination that the procedure reflects typical service delivery. For claims with the “-22″ modifier a description of the need for extended services should accompany the claim. Modifier “-59″ is used to establish one procedure as distinct from another procedure billed on the same day.
Source: asha.org

Loony Medicare rules can turn a hospital visit into a costly adventure

Dennia – Mo.: I retired from an employer who partially paid my medical coverage as part of my retirement compensation in 2013. I did not take Medicare B at 65 because I worked for another company until two weeks ago. I am 66 now and am at full retirement age for Social Security. I discovered that although I have retirement medical coverage partially paid by my ex-employer, I have to pay a penalty for Medicare Part B coverage because I refused it when I turned 65 thinking that since I had retirement coverage and paid more than $675 a month for medical benefits, that I did not need to take Medicare B and pay another $208 a month on top of the $675 I already was paying. To add salt to the wound, I found out that I have to wait until June before Medicare Part B becomes effective. Can you help me understand how they can make me wait until June before I can use Medicare Part B and also have to pay a penalty on top of the $208 each month? The bills I am getting already have reached more than $5,000.
Source: pbs.org

Medicare Advantage: Private Health Insurance Through Medicare

Posted by:  :  Category: Medicare

Medicare Advantage plans may give you some discounts or pay for services that Original Medicare may not cover. However, Medicare Advantage plans are administered by private health insurers and you’ll be required to follow your plan’s rules. Original Medicare allows you to see just about any doctor and go to any hospital that accepts Medicare , which most providers accept. With Medicare Advantage plans, you’re typically restricted to the doctors and hospitals included in the plan’s network. You might need referrals to see a specialist.
Source: webmd.com

How Medicare Advantage Plans work

Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by private companies approved by Medicare. If you join a Medicare Advantage Plan, you still have Medicare. You’ll get your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage from the Medicare Advantage Plan and not Original Medicare.
Source: medicare.gov

How to Obtain Medicare Forms

Posted by:  :  Category: Medicare

Visit the Medicare.gov website and click the "Forms, Help, & Resources" option in the home page menu. The next page has a list of options that include Medicare forms. Clicking that link loads a page that asks a variety of questions about different scenarios, such as "I want to file a claim for services and/or supplies that I got," and provides the appropriate form for download. Filing a claim, for example, requires CMS-1490S, the Patient Request for Medical Payment form.
Source: ehow.com

Medicare Appeals Process Forms

A party may appoint any individual, including an attorney, to act as his or her representative to help the party during the processing of a claim or claims and /or any appeals of claims. A representative may be appointed at any time during the appeals process. The party making the appointment and the individual accepting the appointment must either complete an appointment of representative form (CMS-1696, CMS-1696 Spanish) or use a conforming written instrument. If the form CMS-1696 is not used, the written request must contain all of the elements listed in 42 CFR 405.910. The appointment of representative is valid for one year from the date it is signed by both the party and the appointed representative. A detailed explanation of appointment of a representative can also be found in the CMS Internet Only Manual (IOM) 100-4, Chapter 29, section 270.
Source: findacode.com

Medicare Form, Medicare Forms

This information is available for free in other languages. Please call our customer service number at 1-800-282-5366 (TTY: 711). Hours of operation: 7 days per week, 8 a.m. till 8 p.m. Esta información está disponible en otros idiomas de manera gratuita. Comuníquese con Servicios al Cliente al 1-800-282-5366 (TTY: 711). Horario de atención: de 8 a.m. a 8 p.m., los siete días de la semana.
Source: aetnamedicare.com

Medicare Reform: Premium Support is Incremental

Posted by:  :  Category: Medicare

Contrary to the strong assertions of some, including many who prefer one of the two radical approaches, the familiar and incremental approach is to adopt a premium support model for Medicare. Far from a new idea, the premium support model can be traced back to the Clinton-era National Bipartisan Commission on the Future of Medicare, chaired by Senator John Breaux (D–LA) and Representative Bill Thomas (R–CA).[8] This approach was also outlined in a joint effort by Chairman Ryan and former Clinton Administration Office of Management and Budget Director Alice Rivlin,[9] and it was included in the more recent “Path to Prosperity” budget proposal offered by Chairman Ryan that passed by the House of Representatives in 2010.[10] It has been described most completely in The Heritage Foundation’s Saving the American Dream plan and the Wyden–Ryan plan noted above.[11] Far from a radical approach, every aspect of the Medicare premium support model builds on elements that are common, indeed fundamental to the existing Medicare system. Premium support simply takes these elements to their logical conclusion while tying them together in a cohesive, coherent program.
Source: heritage.org

West Virginia Bureau for Children and Families

West Virginia Bureau for Children and Families NOTE: You are using an outdated browser. In order to view, use, and enjoy this site to the fullest, we strongly recommend upgrading your browser to one that supports web standards.
Source: wvdhhr.org

Medicare Part B Premium History

Part B premium rates are based on the projected cost to the federal government and Congress, an unpredictable factor. Historically, premiums go up each year. For example, Medicare Part B cost recipients $5.30 in 1970. By 1973, it was up to $6.30, though it was reduced to $5.80 in July and $6.10 in August that year. The premiums continued to increase and reached $31.90 per month in 1989. That rate came from the Medicare Catastrophic Coverage Act of 1988, a change that was intended to expand the program to cover some prescription medications and reduce out-of-pocket costs. It was repealed in 1989.
Source: ehow.com

One last push to stop Medicare premium increases

Advocates for the 30 percent are swinging into action, trying to convince Congress to pass a one-time fix that would hold off on cost of living increases for everyone. Legislation that extended the hold harmless provision to those not covered by it passed the House of Representatives when a similar situation occurred in 2009, but never received a vote in the Senate.
Source: reuters.com