Medicare Part D coverage gap

Posted by:  :  Category: Medicare

The Medicare Part D coverage gap (informally known as the Medicare donut hole) is a period of consumer payment for prescription medication costs which lies between the initial coverage limit and the catastrophic-coverage threshold, when the consumer is a member of a Medicare Part D prescription-drug program administered by the United States federal government. The gap is reached after shared insurer payment – consumer payment for all covered prescription drugs reaches a government-set amount, and is left only after the consumer has paid full, unshared costs of an additional amount for the same prescriptions. Upon entering the gap, the prescription payments to date are re-set to $0 and continue until the maximum amount of the gap is reached: copayments made by the consumer up to the point of entering the gap are specifically *not* counted toward payment of the costs accruing while in the gap.
Source: wikipedia.org

The Obameter: Close the "doughnut hole" in Medicare prescription drug plan

The health care bill signed into law by President Barack Obama is poised to “close the ‘doughnut hole’ in the Medicare Part D Prescription Drug Program that limits benefits for seniors with more than $2,250 but less than $5,100 in annual drug costs.” First, some background on the doughnut hole. In 2010, seniors in the Medicare Part D program must pay the first $310 for prescriptions before coverage kicks in. For subsequent total drug costs between $310 and $2,830, the government will pay 75 percent and beneficiaries pay 25 percent. (The numbers are different from Obama’s promise due to increases since he made the statement.) Then, starting at $2,830, beneficiaries must pay the entire costs until they hit an out-of-pocket limit of $4,550. That’s what’s known as the doughnut hole. After that, “catastrophic coverage” begins, with the government paying 95 percent of costs. The hole won’t be closed immediately, but will instead be phased in over the next 10 years. This year, beneficiaries who reach the doughnut hole will receive a $250 rebate. After that, federal subsidies will enable the patient’s share of the payment to be gradually reduced from 100 percent to 25 percent by 2020. At 25 percent, the doughnut hole range will have the same co-pay rate as the prior range. Separately, brand-name drugmakers will be obligated to provide discounts for prescriptions filled through Medicare Part D starting in 2011. The hole will hang on for a while, but its eventual disappearance is now enshrined in law. Since Obama did not specify a timeline in his promise, we are rating it a Promise Kept.
Source: politifact.com

How to Get a Medicare Provider Number (7 Steps)

Posted by:  :  Category: Medicare

A Medicare provider number is known as a “national provider identifier,” a ten-digit identification number for covered health care providers. The Centers for Medicare and Medicaid Services state that covered health care providers, health care plans and health care clearinghouses are required to have national provider identifiers for administrative and financial transactions under the Health Insurance Portability and Accountability Act (HIPAA). In order to obtain a national provider identifier, you will have to apply. You can download an application and mail it in or fill out the application and apply online.
Source: ehow.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

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

Medicare Advantage Plans In Florida

By offering multiple options, Florida Blue allows you to sign up for the one that is right for you. Then, you can ensure that you have the coverage that you need when you need it. Plus, you don’t have to worry about paying for additional services that you know you won’t use. For example, if you know that you don’t mind seeing in-network providers for your healthcare and do not mind getting referrals when you need to see a specialist, you can choose a more affordable HMO plan. This can help you keep more money in your pocket, which is especially important if you are in retirement and are living on a fixed income.
Source: medicareadvantageplansinflorida.org

Medicare Supplement and Medicare Advantage Plans in Texas

Posted by:  :  Category: Medicare

From Houston to Plano, San Antonio to Corpus Christi, Dallas/Ft. Worth to Austin, El Paso to Arlington, Amarillo, Beaumont, Brownsville, Denton, Frisco, Garland, Irving, Laredo, Lubbock, Pasadena or Waco it is important that you find the medicare coverage that fits your life and your lifestyle. We feel that the best care is received when you have your choice of Doctors, and you and your Doctor make your medical decisions. Medigap plans in Texas are available with no medical underwriting during your initial enrollment period. This is when you become eligible for Medicare Part B. You may however, apply to a company and fill out the medical underwriting questions at any time. We are pleased to introduce our Texas Medicare Supplement Comparison Quoting System. It is a very simple process where you enter a few bits of information and then we will quote all of the medicare supplement plans offered by several companies. The companies that we select to quote are based on their strong reputations and competitive pricing. Some of the companies that we represent are: Aetna, BlueCross BlueShield of Texas, Combined Insurance, Equitable Life, Heartland National, Omaha Insurance Company, Standard Life & Casualty, UCT, United American and UnitedHealthcare
Source: medicare-texas.net

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

What Is Medicare Risk Adjustment?

Posted by:  :  Category: Medicare

Medicare managed care providers track and report patient diagnoses to Medicare. There is a specific diagnostic code for each illness and the severity of each illness. Medicare has developed four payment models to increase accuracy: new enrollee, end stage renal disease, long-term care institutional and a community model.
Source: ehow.com

Health Plan Medicare Advantage Risk Adjustment

Optum provides end-to-end support to help plans deliver high-quality care, manage increasing health care costs, and achieve payment accuracy. Our risk adjustment services help Medicare Advantage, Managed Medicaid, and Commercial/Exchange plans support accurate reimbursement while streamlining risk management processes and assisting in improving quality of care. Through our integrated solutions, Optum helps:
Source: optum.com

Florida Department of Children and Families

Posted by:  :  Category: Medicare

This may result in fines of up to $250,000, a prison term or both, if you are convicted of public assistance fraud. In addition you will not be able to get benefits for 12 months the first time, 24 months the second time, and permanently the third time that you provide false or inaccurate information.
Source: myflorida.com

Coventry Health Care of Florida: Home

Learn more about the Affordable Care Act and what it means to you. View important health care reform information on our corporate site. 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, please contact us using the appropriate number.
Source: coventryhealthcare.com

2016 Florida 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 $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

How to Become a Medicare Provider

A completed Medicare provider application goes to the appropriate state agency, which checks the application and supporting documents for completeness and accuracy. For a health-care facility, the agency will provide a time frame in which you can expect an unannounced inspection to verify that your facility meets Medicare standards. Although an inspection is standard during enrollment, state agencies have the authority to conduct random unannounced inspections at any time. Once verifications and inspections are complete, the agency makes a recommendation and forwards the applications and results to the CMS for final approval or rejection.
Source: ehow.com

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

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

FLORIDA MEDICAID APPLICATION

Medicaid serves primarily low-income families, children, related caretakers of dependent children, pregnant women, people age 65 and older, and adults and children with disabilities. Initially, the program was only available to people receiving cash assist ance Temporary Assistance for Needy Families (TANF) or Supplemental Security Income (SSI). During the late 1980s and early 1990s, Congress expanded the Medicaid program to include a broader range of people, including older adults, people with disabilities and pregnant women. While individuals receiving TANF and SSI cash assistance continue to be automatically eligible for Medicaid, these and other federal changes declines Medicaid eligibility from receipt of cash assistance.
Source: floridamedicaidapplications.com

Health Insurance, Dental Insurance & Other Insurance Plans

Posted by:  :  Category: Medicare

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

Medicare Open Enrollment 2016

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

American Continental Insurance Company

An Advantage plan offers more choice (hence it is often referred to as Medicare + Choice or Medicare Part C). With one of these versatile plans, you can tailor your insurance to suit your individual requirements. They can be more costly than other Medicare options, sure, but depending on your circumstances, they can save you a lot of money in the long run. Medicare Advantage Plans have almost doubled in popularity since 2007, with 8 million citizens opting for one of these plans which can cover you for dental care, vision services, travel insurance and a whole lot more besides.
Source: bestmedicaresupplement.com

Medicare Part D and Medicare Advantage Plan Customer Help Desk

No problem. You can begin by browsing through our Q1Medicare Frequently Asked Questions (FAQs). After going to the FAQ section, you will find the different FAQ categories on the right side of the page. Simply click on one of the FAQ categories or use our Search box at the top of the page. You may find that a similar question has already been asked by another Q1Medicare user like yourself. Here are a few examples of commonly asked Medicare Part D and Medicare Advantage plan questions:
Source: q1medicare.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 Supplemental Insurance by 1

Posted by:  :  Category: Medicare

 A Medicare Supplement Plan, or Medigap, is a type of medicare health insurance that is sold by private insurance companies and is specifically designed to help you by filling in the “gaps” of Original Medicare. In order to purchase a Medigap plan you must be enrolled in Medicare Part A and B, and you will continue to pay your monthly Part B premium. You would then pay your Medigap premium and as long as your premium gets paid you will have the benefit of guaranteed renewable coverage. What this means is that the insurance company cannot cancel your policy.   There are several different plan types available to consider, but it is important to note that Medigap policies are “standardized.” This means that they are required to abide by the Federal and State laws that are put in place to protect you. The standardized policies must provide you with the same benefits no matter what company sells them and generally the only difference from company to company, if it is the same plan type, is the cost. Many couples would like to be covered under the same policy, but you and your spouse must each purchase your own individual policies. In some instances you might be allowed to purchase a Medicare Supplement plan that is guaranteed issue without any medical underwriting! This means that you cannot be denied coverage. 
Source: youandmedicare.com

2012 Medicare Part D Program Compared to 2011, 2010, 2009 and 2008

Pharmaceutical manufacturers will be required to provide certain beneficiaries access to discount prices for certain brand drugs purchased under Medicare Part D. The manufacturer discount prices will be equal to 50% of the plan’s negotiated price defined (minus any applicable dispensing fees). These discount prices must be applied prior to any prescription drug coverage or financial assistance provided under other health benefit plans or programs and after any supplemental benefits provided under the Part D plan. The discounted prices will be charged at the pharmacy (point-of-sale). The beneficiary will not have to do additional paperwork, etc. to receive the benefit. These manufacturer discount prices will be made available to Part D enrollees who are in the coverage gap or donut hole (they have reached or exceeded the initial coverage limit and have incurred costs below the annual out-of-pocket threshold). Medicare beneficiaries will not be eligible to receive these discount prices if they are enrolled in a qualified retiree prescription drug plan or are eligible for the low-income subsidy. The costs paid by manufacturers towards the negotiated prices of drugs covered under this manufacturer discount program shall be considered incurred costs for eligible beneficiaries and applied towards their out-of-pocket threshold. This means that the total negotiated retail drug price will be applied to the TrOOP and will count toward getting out of the doughnut hole.
Source: q1medicare.com

Medicare Guide for Boomers

3. Do enroll when you’re supposed to: To avoid permanent late penalties, enroll at age 65 if you don’t have insurance from an employer for whom you or your spouse is still working or if you live abroad without working; or, beyond 65, enroll within eight months of stopping work — even if you continue to receive COBRA or retiree health benefits from an employer.
Source: aarp.org

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

MedicareMall Homepage 2015

Original Medicare Part A and Part B covers approximately 80% of your Medicare approved Medical expenses and limited Hospitalization coverage. A Medicare Supplement (also known as Medigap Plan) will help you cover those expenses. Our most popular Medigap Plans are Plan F, Plan G, and Plan N.
Source: medicaremall.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

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