Questions About Wellpoint Medicare Advantage Plans?

Posted by:  :  Category: Medicare

One thing that separates WellPoint is the amount of information and educational tips that the company provides for members. Various workshops and programs are provided to help members maintain their health in-between doctor visits. WellPoint has been praised recently for some of its programs, including a health improvement program that targets diabetes. Insured individuals who enroll in this program are 27 percent less likely to go to the hospital than those who are not.
Source: medicare.net

Obamacare and Medicare Advantage: How WellPoint Could Outperform

Due in part to a desire to maintain its Blue Cross Blue Shield brand value, WellPoint has been among the most active in public exchanges under the Affordable Care Act – participating in 14 exchanges and on the way to enrolling 700,000 lives. That’s well ahead of Aetna’s 450,000 estimate and due in part to the markets involved – Aetna is active in more exchanges (17), but WellPoint has a large presence in California (about one-third of enrollees), Virginia, and Georgia. By way of comparison, UnitedHealth, Cigna, and Health Net have only token presences in public exchanges, though UnitedHealth has commented on possibly getting more active for 2015 (and early filings indicate they will be substantially increasing their footprint).
Source: fool.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

Tufts Health Plan Medicare Preferred

In 2016, our HMO plans earned 5 out of a possible 5 Stars by the Center for Medicare and Medicaid Services. This rating combines the scores our plans received for the various medical and/or prescription drug services our plans offer.
Source: tuftsmedicarepreferred.org

Dentists must choose to opt in or out of Medicare enrollment

Posted by:  :  Category: Medicare

Any dentist who treats Medicare beneficiaries must either enroll in the program or opt out in order to prescribe medication to their qualifying patients with Part D drug plans, according to the federal government. Either way, dentists who fit this requirement must take action by June 1, 2015. They either have to opt in or opt out. The Centers for Medicare and Medicaid Services published a final rule in May that requires all physicians and eligible professionals—including dentists—who prescribe Part D covered drugs to be enrolled in Medicare or opt out for those prescriptions to be covered under Part D. By signing an affidavit opting out of the program, and entering into private contracts with patients as appropriate, dentists are out of Medicare for two years and cannot receive any direct or indirect Medicare payment for services provided to Medicare patients.   CMS officials project that by requiring eligible providers to enroll, it will save the federal government an estimated $1.6 billion over the next 10 years. “The policies finalized in this regulation will strengthen Medicare by providing better protections and improving health care quality for beneficiaries participating in Medicare health and drug plans,” said Marilyn Tavenner, CMS administrator. “The final rule will give CMS new and enhanced tools in combating fraud and abuse in the Medicare Part D program so that we can continue to protect beneficiaries and taxpayers.” It’s a change the ADA does not agree with and one Association leadership voiced their concern about in a March 5 letter. ADA President Charles Norman and Executive Director Kathleen O’Loughlin sent a letter to CMS asking that dentists be excluded from the requirement because it “places an unnecessary burden on dentists and their Medicare eligible patients,” and it will not address the underlying rationale for a portion of the law, which is to stop fraud and abuse in the Medicare program. In 2010, only an estimated 3-4 percent of the 186,000 practicing dentists were enrolled as Medicare providers, likely because the program only covers a limited set of dental procedures, most of which are recognized by CMS as necessary before the patient has certain covered medical procedures, Drs. Norman and O’Loughlin wrote in the letter. “There is no reason to believe that the number of enrolled dentists has risen significantly because of the relative modest impact of the ordering and referring provision,” the letter stated. “On the other hand, this new requirement will affect the majority of dental practices.” Despite the ADA’s expressed concerns, CMS moved forward with the enrollment or opt-out requirement. “Dentists who don’t take action won’t see an impact until next year but it will be when their local pharmacy or patient starts to complain that they are not being reimbursed for the prescriptions the dentist writes,” said Dr. Andrew Vorrasi, chair of the Council on Dental Benefit Programs. “We’re not sure how the pharmacies will handle this. Will they refuse to accept the prescription? Will they accept the prescription but force the patient to pay and tell them it’s because Medicare won’t reimburse the pharmacy or patient because their dentist didn’t comply with the law? How will the patients react if they file their own claim for reimbursement that is denied? While the ADA opposed this action, it is one of those situations where the decision was beyond our control. Complying with this law will save practitioners much time and aggravation come June 15, 2015.” To read more on Medicare enrollment and access other Medicare resources, please go to Success.ADA.org/medicare.
Source: ada.org

Dentists become durable medical equipment suppliers for sleep apnea oral appliances

For Medicare to cover oral appliances for OSA, specific criteria must be met. The good news is that Medicare does spell out what’s needed in their policy, called the Local Coverage Determination (LCD) for Oral Appliances for OSA. To locate the policy and coding guidelines, search for “LCD for Oral Appliances for OSA” on the Internet. 
Source: dentistryiq.com

Is There a Dental Plan for Medicare Patients?

Original Medicare specifically excludes most dental work, such as cleanings, fillings and dentures. There are exceptions, and Medicare Part A covers dental services that you receive in the hospital related to another illness. Medicare also may cover basic hospital care if you’re admitted as an inpatient because of a dental emergency. In addition, some Medicare Advantage plans offer more dental coverage than original Medicare.
Source: ehow.com

Medicare Part D coverage gap

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

Medicare Plan Finder for Health, Prescription Drug and Medigap plans

Posted by:  :  Category: Medicare

The page could not be loaded. The Medicare.gov Home page currently does not fully support browsers with "JavaScript" disabled. Please note that if you choose to continue without enabling "JavaScript" certain functionalities on this website may not be available.
Source: medicare.gov

Tufts Health Plan Medicare Preferred

In 2016, our HMO plans earned 5 out of a possible 5 Stars by the Center for Medicare and Medicaid Services. This rating combines the scores our plans received for the various medical and/or prescription drug services our plans offer.
Source: tuftsmedicarepreferred.org

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/Medicaid Health Plan Rankings 2014

NCQA evaluated 507 Medicare health plans and ranked 408 of those based on clinical performance, member satisfaction and NCQA Accreditation. To be eligible for rankings, health plans must authorize public release of their performance information and submit enough data for statistically valid analysis. NCQA’s Health Insurance Plan Rankings 2014-2015 used NCQA’s established rankings methodology, which has been used and widely recognized since 2005. The NCQA Accreditation status in these rankings is as of June 30, 2014. Please click 
Source: ncqa.org

Overview of Medicare Part B

While Medicare Part B will most likely pay for most of your outpatient medical expenses, you still may have some out-of-pocket costs. So, you may want to consider a Medigap plan to help pay these out-of-pocket costs such as the annual Part B deductible, coinsurance charges and copayments. If you enroll in a Medicare Advantage plan, some of these costs may also be covered.
Source: about.com

FL Medicare Plan Wins 5 Stars

The state has such a competitive market that many plans charge no premium, including CarePlus’ five-star plans and some other companies’ plans that won 4 1/2 stars. In fact, in some counties plans with high ratings even reimburse Medicare beneficiaries for some of their Part B monthly premium of $104.90 — a deal that’s almost unheard-of elsewhere in the country.
Source: usf.edu

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

Coventry Medicare: Advantra (HMO/PPO)

Whether you are an employer, health care provider, someone interested in enrolling, or already a current member, our goal is to provide you with valuable and convenient online resources and information. Come explore the ways in which we can help you take charge of your Medicare Advantage coverage.
Source: coventryhealthcare.com

Pennsylvania Medicare Supplement Plans

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

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

2015 Medicare Advantage Plans Available to Residents of Pennsylvania

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

Unique Physician Identification Number (UPIN) Directory

Posted by:  :  Category: Medicare

The Unique Physician Identification Number (UPIN) Directory contains selected information on physicians, doctors of Osteopathy, limited licensed practitioners and some non-physician practitioners who are enrolled in the Medicare Program. The data elements in the file (UPIN, full name, specialty, Physician License State Code, zip code, Medicare provider billing number and State) are extracted from the UPIN Database and are approved for public release in the Centers for Medicare & Medicaid Services (CMS) System of Records. The file is updated quarterly with updates being available usually by April 15, July 15, October 15, and January 15. Each update file is considered as a replacement file.
Source: cms.gov

Difference between the Medicare Provider Numbers

Applicable FARSDFARS Restrictions Apply to Government Use. This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60654. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (November 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements.
Source: wpsmedicare.com

Medicare Plan Finder – Search by Plan Name and/or ID

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

National Provider Identifier Standard (NPI)

The National Provider Identifier (NPI) is a Health Insurance Portability and Accountability Act (HIPAA) Administrative Simplification Standard. The NPI is a unique identification number for covered health care providers. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA. The NPI is a 10-position, intelligence-free numeric identifier (10-digit number). This means that the numbers do not carry other information about healthcare providers, such as the state in which they live or their medical specialty. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions.
Source: cms.gov

Medicare – Check Your Enrollment

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

How to Prevent Medicare Card Identity Theft

Note: You’ll notice that your Medicare ID has one or two additional letters or numbers following the digits of the SSN. These identify what kind of beneficiary you are, according to the Social Security Administration. For example, the letter T mainly indicates that you are entitled to Medicare, but are not yet filed for Social Security retirement benefits; whereas W1 indicates that you are a widower who is eligible for Medicare through disability. For the purposes of your photocopy, it doesn’t matter whether you delete these final letters (or letter-number combinations) or leave them in.
Source: aarp.org

Getting and Replacing Your Medicare Card

If you are almost 65 and not yet receiving retirement benefits: It is important to note that not all beneficiaries are automatically enrolled in Medicare. If you are not yet receiving retirement benefits, close to turning 65, you will need to enroll in Medicare Part A and/or Medicare Part B during your Initial Enrollment Period (IEP), which begins three months before you turn 65 and lasts seven months. You can apply for Medicare Part A and/or Part B through Social Security (if you worked for a railroad, you need to apply through the Railroad Retirement Board). The start of your coverage will depend on which month you sign up during your IEP, and you should receive your Medicare card within 30 days of being approved.
Source: ehealthmedicare.com

Blue Medicare PPO and Blue Medicare HMO Providers

Posted by:  :  Category: Medicare

Blue Cross and Blue Shield of North Carolina is an HMO, PPO, and PDP plan with a Medicare contract. Enrollment in Blue Cross and Blue Shield of North Carolina depends on contract renewal. Blue Cross and Blue Shield of North Carolina does not discriminate based on race, ethnicity, national origin, religion, gender, age, mental or physical disability, health status, claims experience, medical history, genetic information, evidence of insurability or geographic location within the service area. All Blue Cross and Blue Shield of North Carolina items and services are available to all eligible beneficiaries in the service area.
Source: bcbsnc.com

About the Blue Cross and Blue Shield Association

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 reveals that women are receiving less aggressive treatments after a heart attack than men. Following a heart attack, women are 27% less likely than men to receive angioplasties to open clogged arteries and are 38% less likely than men to undergo coronary bypass surgery. Read the full report.
Source: bcbs.com

Income Limits for Medicare

Posted by:  :  Category: Medicare

The Qualified Medicare Beneficiary program helps to cover the premiums for Parts A and B, plus deductibles, co-payments and co-insurance. The income limits for 2010 are $923 per month for an individual and $1,235 for a married couple. The Specified Low Income Medicare Beneficiary and Qualified Beneficiary programs only help pay Part B premiums. The income limits for these are $1,103 and $1,239 for a single person and $1,477 and $1,660 for married couples, respectively. Finally, the Qualified Disabled and Working Individuals program helps pay for Part A premiums only. The income limits imposed are $3,695 monthly for an individual and $4,942 monthly for a married couple.
Source: ehow.com

California Health Advocates: Medicare Policy, Advocacy and Education

Posted by:  :  Category: Medicare

» Ryan Coble from the Office of Inspector General will discuss durable medical equipment (DME) fraud. Topics include: common DME fraud schemes; DME case examples; and trends and hotspots. She will also discuss what SMPs, beneficiaries and their representatives can look for to detect DME fraud, and what information to provide the OIG when referring DME fraud cases. Due to the law enforcement sensitive information, this training will not be recorded. Register today!
Source: cahealthadvocates.org

Find a 2015 CA Medicare Part D Plan

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

Canada’s Health Care System (Medicare)

Canada’s national health insurance program, often referred to as "Medicare", is designed to ensure that all residents have reasonable access to medically necessary hospital and physician services, on a prepaid basis. Instead of having a single national plan, we have a national program that is composed of 13 interlocking provincial and territorial health insurance plans, all of which share certain common features and basic standards of coverage. Framed by the Canada Health Act, the principles governing our health care system are symbols of the underlying Canadian values of equity and solidarity.
Source: gc.ca

Medicare Supplemental Insurance

Posted by:  :  Category: Medicare

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 Fraud Reporting Center

Medicare Whistleblowers are typically healthcare professionals who are aware of hospitals, clinics, pharmacies, Nursing Homes, Hospices, long term care and other health care facilities that routinely overcharge or seek reimbursement from government programs for medical services not rendered, drugs not used, beds not slept in and ambulance rides not taken. If you have information about a person or a company that is cheating the Medicare program (or any other government run healthcare program), you may be able to collect a large financial reward for reporting it here.
Source: medicarefraudcenter.org