US Laws / Medicare Laws : Online Resources

Posted by:  :  Category: Medicare

CMS, Center for Medicare & Medicaid Services, Medicare laws, Medicaid laws, Medicare regulations, Medicare rules, Medicaid regulations, Medicaid rules, US Health Care Finance Adminstration, Health Care Finance Adminstration, HCFA, HCFA laws, HCFA rules, HCFA regulations, Health Care Finance Adminstration rules
Source: thesafetylibrary.com

Medicare Information, Help, and Plan Enrollment

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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 Supplement Coverage for those Under 65

"I did some research on supplemental policies on my own and felt that I had the facts I needed to make a purchase decision directly with one of the companies I had identified. To be certain I was considering all the factors involved, I decided to contact your organization through your website through an Internet search and was quickly contacted by Leslie Jablonski. During our consultation, two additional points came out that I did not know from my own investigation. As a result, I decided to coordinate my policy purchase with her. Leslie was professional and helpful and I would recommend her and your organization to others seeking advice on Medicare supplemental plans. Shopping with Medigap Advisors was an uncomplicated and very satisfactory experience."
Source: medigapadvisors.com

Medicare Supplement Insurance Quote Engine

In addition to Medicare supplement insurance, we are pleased to be participating in the Medicare Advantage market. The Medicare Advantage policy is a low cost alternative to a Medicare supplement policy and is especially advantageous for those less than 65 years old. The Private Fee For Service (PFFS) is a type of Advantage plan that allows Medicare recipient to visit any doctor, any hospital, anywhere. Therefore, many Medicare recipients are well served by the lower cost Private Fee For Service plan.
Source: bestmedicaresupplement.com

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

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

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

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

Posted by:  :  Category: Medicare

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

2016 Tennessee 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

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

Extra Help with Medicare Prescription Drug Plan Costs

Posted by:  :  Category: Medicare

Medicare beneficiaries can qualify for Extra Help with their Medicare prescription drug plan costs. The Extra Help is estimated to be worth about $4,000 per year. To qualify for the Extra Help, a person must be receiving Medicare, have limited resources and income, and reside in one of the 50 States or the District of Columbia.
Source: ssa.gov

Medicare Prescription Drug, Improvement, and Modernization Act

The bill came to a vote at 3 a.m. on November 22. After 45 minutes, the bill was losing, 219-215, with David Wu (D-OR-1) not voting. Speaker Dennis Hastert and Majority Leader Tom DeLay sought to convince some of dissenting Republicans to switch their votes, as they had in June. Istook, who had always been a wavering vote, consented quickly, producing a 218-216 tally. In a highly unusual move, the House leadership held the vote open for hours as they sought two more votes. Then-Representative Nick Smith (R-MI) claimed he was offered campaign funds for his son, who was running to replace him, in return for a change in his vote from “nay” to “yea.” After controversy ensued, Smith clarified no explicit offer of campaign funds was made, but that he was offered “substantial and aggressive campaign support” which he had assumed included financial support.
Source: wikipedia.org

Medicare Advantage and Prescription Drug Plan Fact Sheet

Kaiser Family Foundation describes MA payments as follows: “ Since 2006, Medicare has paid plans under a bidding process….The ACA of 2010 revised the methodology for paying plans and reduced the benchmarks…Reductions in benchmarks will be phased-in over 2 to 6 years between 2012 and 2016.  By 2017, when the new benchmarks are fully phased-in, the benchmarks will range from 95% of traditional Medicare costs in the top quartile of counties with relatively high per capita Medicare costs (e.g., Miami-Dade), to 115% of traditional Medicare costs in the bottom quartile of counties with relatively low Medicare costs (e.g., Boise).The ACA specified that plans with higher quality ratings would receive bonus payments added to their benchmarks, beginning in 2012.  The ACA also reduced rebates for all plans, but allowed plans with higher quality ratings to keep a larger share of the rebate than plans with lower quality ratings.  A CMS demonstration was implemented in 2012 that superseded bonuses specified by the ACA, raised the size of the bonus payments, and increased the number of plans that would receive bonus payments, providing an additional $8 billion in bonuses between 2012 and 2014.” 8
Source: medicarehmo.com

Medicare Part D Plans, Prescription Drug Plan (PDP)

Aetna Medicare is a PDP, HMO, PPO plan with a Medicare contract. Our SNPs also have contracts with State Medicaid programs. Enrollment in our plans depends on contract renewal. See Evidence of Coverage for a complete description of benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by location. ©2015 Aetna Inc. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, formulary, pharmacy network, provider network, premium and/or copayments/coinsurance may change on January 1 of each year. 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. Our dual-eligible Special Needs Plan is available to anyone who has both Medical Assistance from the state and Medicare. Premiums, copays, coinsurance and deductibles may vary based on the level of Extra Help that you receive. Please contact the plan for further details. You must continue to pay your Medicare Part B premium. The Part B premium is covered for full-dual members. This information is available for free in other languages. Please call our customer service number at 1-866-865-0662 (TTY: 711) OR Coventry Health Care at 1-877-988-3589 (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. Esta información está disponible en otros idiomas de manera gratuita. Comuníquese con Servicios al Cliente al 1-866-865-0662 (TTY: 711), de 8 am a 8 pm, siete días a la semana, desde el 1º de octubre hasta el 14 de febrero, y de 8 am a 8 pm, de lunes a viernes, desde el 15 de febrero hasta el 30 de septiembre. Medicare beneficiaries may also enroll in Coventry plans through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov. For mail-order, you can get prescription drugs shipped to your home through the network mail-order delivery program. Typically, mail-order drugs arrive within 7 to 14 days. You can call First Health Part D at 1-866-865-0662 (TTY: 711), 8 a.m. to 8 p.m., local time, seven days, from October 1 – February 14; 8 a.m. to 8 p.m. Monday – Friday, from February 15 – September 30, if you do not receive your mail-order drugs within this timeframe. Members may have the option to sign-up for automated mail-order delivery. Cost sharing for members who get “Extra Help” is the same at preferred and network pharmacies. The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary. Participating physicians, hospitals and other health care providers are independent contractors and are neither agents nor employees of Aetna. The availability of any particular provider cannot be guaranteed, and provider network composition is subject to change. This material is for informational purposes only and is not medical advice. Health information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professional. Contact a health care professional with any questions or concerns about specific health care needs. Providers are independent contractors and are not agents of Aetna. Provider participation may change without notice. Aetna is not a provider of health care services and, therefore, cannot guarantee any results or outcomes. The availability of any particular provider cannot be guaranteed and is subject to change. Information is believed to be accurate as of the production date; however, it is subject to change. For more information about Aetna plans, refer to www.aetnamedicare.com
Source: coventryhealthcare.com

Drug Finder: Find which 2016 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

How to Enroll in a Medicare Part D Drug Plan

Medicare Rights Center The Medicare Rights Center, an independent, non-profit group, is the largest organization in the United States (aside from the federal government) that provides information and assistance for people with Medicare. Its site has a section about Medicare Part D drug coverage, including information about programs that could help you pay for your prescription drug costs. A unique feature of the site is the Medicare Interactive Counselor, a tool that walks you through the process of finding the drug plan that makes sense for you.
Source: about.com

Medicare Prescription Drug, Improvement, and Modernization Act

Posted by:  :  Category: Medicare

The bill came to a vote at 3 a.m. on November 22. After 45 minutes, the bill was losing, 219-215, with David Wu (D-OR-1) not voting. Speaker Dennis Hastert and Majority Leader Tom DeLay sought to convince some of dissenting Republicans to switch their votes, as they had in June. Istook, who had always been a wavering vote, consented quickly, producing a 218-216 tally. In a highly unusual move, the House leadership held the vote open for hours as they sought two more votes. Then-Representative Nick Smith (R-MI) claimed he was offered campaign funds for his son, who was running to replace him, in return for a change in his vote from “nay” to “yea.” After controversy ensued, Smith clarified no explicit offer of campaign funds was made, but that he was offered “substantial and aggressive campaign support” which he had assumed included financial support.
Source: wikipedia.org

Fraud Still Plagues Medicare Drug Program, Watchdog Finds

New York and Los Angeles remain hotbeds for questionable prescribing, with far higher use of expensive drugs associated with fraud than other parts of the country. The New York metropolitan area, for instance, accounted for half of all prescriptions for the expensive topical ointment Solaraze last year, a disproportional rate. The drug is used for lesions formed as a result of overexposure to the sun. New York and Los Angeles also stood out for prescribing of two omega-3 fatty acids, used to help reduce very high triglyceride levels. The two regions accounted for nearly half of all prescriptions for Vascepa and about a third of those for Lovaza.
Source: propublica.org

Extra Help with Medicare Prescription Drug Plan Costs

Medicare beneficiaries can qualify for Extra Help with their Medicare prescription drug plan costs. The Extra Help is estimated to be worth about $4,000 per year. To qualify for the Extra Help, a person must be receiving Medicare, have limited resources and income, and reside in one of the 50 States or the District of Columbia.
Source: ssa.gov

Fraud Still Plagues Medicare’s Prescription Drug Program : Shots

New York and Los Angeles remain hot spots for questionable prescribing, with far higher use of expensive drugs associated with fraud than other parts of the country. The New York metropolitan area, for instance, accounted for half of all prescriptions for the expensive topical ointment Solaraze last year, a disproportional rate. The drug is used for lesions formed as a result of overexposure to the sun. New York and Los Angeles also stood out for prescribing of two omega-3 fatty acids, used to help reduce very high triglyceride levels. The two regions accounted for nearly half of all prescriptions for Vascepa and about a third of those for Lovaza.
Source: npr.org

Competition and the Cost of Medicare’s Prescription Drug Program

The difference in average drug prices between Part D and Medicaid in 2010 occurred primarily because Medicaid’s statutory rebates on brand-name drugs were generally much larger than the rebates on those drugs negotiated by plan sponsors in Part D. Rates of generic drug use were similar in the two programs, so the higher prices paid by Part D for brand-name drugs were not offset by significantly greater use of generic drugs. However, the higher prices for given brand-name drugs were offset in part by greater use in Part D of lower-priced drugs within therapeutic classes (groups of drugs that are intended to treat common sets of medical conditions and that typically have similar modes of action). If the different patterns of use within therapeutic classes stemmed entirely from differences in the structure of the programs, then the lower end of those ranges—27 percent in 2010 and at least 20 percent in the future—reflects the relative effectiveness of those program structures in containing drug prices. If, instead, the different patterns of use within therapeutic classes stemmed entirely from differences in health conditions between beneficiaries of the programs, then the higher end of those ranges—38 percent in 2010 and at least 30 percent in the future—reflects the relative effectiveness of those program structures in containing drug prices.
Source: cbo.gov

What are Medicare Advantage Plans?

Posted by:  :  Category: Medicare

Medicare Advantage Plans are health plans that are approved by Medicare and provided by private companies such as Aetna, Cigna, Coventry, Health Net, Humana, United HealthCare, WellCare, and many others. Medicare sets the rules for Medicare Advantage Plans and regulates the private companies who operate the Plans. Medicare Advantage Plans are also sometimes referred to as Medicare Health Plans, Medicare Part C Plans, and MAs/MA-PDs (and originally, Medicare Advantage Plans were called Medicare+Choice plans). A Medicare Advantage Plan combines your Medicare Hospitalization (or Medicare Part A) and Medical insurance or Doctor’s Visit Coverage (or Medicare Part B) into one Health Plan that provides the same Medically-Necessary Services as Original Medicare. Some, but not all Medicare Advantage Plans also offer Prescription Drug Coverage (or Medicare Part A and Medicare Part B and Medicare Part D) at no additional cost and are called MA-PDs.
Source: q1medicare.com

How Is Medicare Advantage Funded?

Medicare Advantage is an alternative to traditional Medicare in which health care coverage is provided by private insurance companies, which are reimbursed by the federal government. Medicare Advantage is funded by Medicare and by people who sign up for the plans. With the exception of hospice care, Medicare Advantage must offer at least the same hospital and medical coverage as original Medicare. In return, Medicare pays a fixed amount to the insurance companies every month to help finance this coverage. If you choose an Advantage plan, you’ll also help pay for its costs through premiums and other charges.
Source: ehow.com

Medicare Advantage reduction pass

The Centers for Medicare & Medicaid Services “was obligated to reduce the payments it made to MAOs (Medicare Advantage organizations) by the 2 percent sequester, in effect, a premium reduction to MAOs,” lawyers for the health system argued.

 The sequestration “could not apply to the payments from an MAO to a health care system as that payment was governed exclusively by the contract between the MAO and the system. That is, the sequester could only be taken (or the premium reduction passed along to providers) if the contract permitted the MAO to do so,” they wrote in the lawsuit, filed in Pennsylvania federal court.
Source: healthcarepayernews.com

How to Become a Medicare Advantage Insurance Agent

Medicare Advantage plans are essentially managed care Medicare health plans that replace Medicare Part A (hospitalization) and Part B (medical insurance). Licensed health insurance sales agents can directly sell Medicare Advantage plans to individuals if they have contracts with the companies that offer these plans. As an agent, you can work independently or through a brokerage or insurance company to sell insurance to Medicare eligible recipients.
Source: chron.com

Medicare Advantage Premiums & Costs

Posted by:  :  Category: Medicare

Remember that a Medicare Advantage plan may have more costs than its monthly premiums alone. Beneficiaries may have copayments, coinsurance, and deductibles associated with doctors’ visits, hospital stays, and other health-care services. Beneficiaries also have out-of-pocket expenses associated with medications, including deductibles and copayments. In general, Medicare Advantage plans have a maximum allowable deductible that they can charge, but they also have the option to reduce or eliminate this deductible.
Source: planprescriber.com

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

An Unexpected Spike for Medicare Premiums?

Unless the U.S. Department of Health and Human Services intervenes, some Medicare beneficiaries will face a steep increase in their 2016 premiums, even as the vast majority of Medicare recipients pay no increase at all.
Source: wsj.com

Elderly Pharmaceutical Insurance Coverage (EPIC) Program

Posted by:  :  Category: Medicare

The Elderly Pharmaceutical Insurance Coverage (EPIC) program is a New York State program for seniors administered by the Department of Health. It helps more than 265,000 income-eligible seniors aged 65 and older to supplement their out-of-pocket Medicare Part D drug plan costs. Seniors can apply for EPIC at any time of the year and must be enrolled or eligible to be enrolled in a Medicare Part D drug plan to receive EPIC benefits and maintain coverage.
Source: ny.gov

Medicaid and the Medicare Savings Programs 2015

Applications for these programs may be obtained from the Medicaid office at the local (county) Department of Social Services. Or, you may print the application form from the link below. All applications for the Medicare Savings Program must be mailed to the local Department of Social Services where you live. The phone number and address for the local Department of Social Services may be found in the government pages of the telephone book.
Source: ny.gov

New York State Office for the Aging

is to help older New Yorkers be as independent as possible for as long as possible through advocacy, development and delivery of person-centered, consumer-oriented, and cost-effective policies, programs and services which support and empower older adults and their families, in partnership with the network of public and private organizations which serve them.
Source: ny.gov

Federal Health Care Reform Implementation in New York State

Also included on this website are timelines that describe when specific provisions of health care reform go into effect. Several reforms took effect in 2010, including a temporary pre-existing condition insurance plan for residents with medical conditions that are expensive to treat, an early retiree reinsurance program that will help offset the cost of providing health insurance to retirees age 55 and over who are not eligible for Medicare, and the mailing of rebate checks to Medicare Part D enrollees who reach the “donut hole” coverage gap.
Source: ny.gov

Office of Temporary and Disability Assistance

Project Will Provide Housing, Services to Address Mental Health and Substance Abuse Issues – The New York State Office of Temporary and Disability Assistance (OTDA) today announced that $7.9 million is being awarded to The Rescue Mission Alliance of Syracuse to construct 128 units of permanent supportive housing in Onondaga County. The announcement was made during the grand opening of the Rescue Mission’s 183-bed homeless shelter, which was constructed with a $3.4 million grant from OTDA, and highlighted as part of Governor Cuomo’s “Capital for a Day” in Central New York.
Source: ny.gov

Medicare Plans are Confusing, We Make Medicare Less Frustrating.

Posted by:  :  Category: Medicare

Medicare Advantage insurance is a replacement to Original or Traditional Medicare Parts A and B – it is offered instead by private insurance companies. Medicare Advantage plans generally feature additional benefits and have less cost-sharing than Traditional Medicare, and you may be required to pay a monthly premium in exchange for the added benefits that the Medicare Advantage plan features. Medicare Advantage plans come in many different flavors and formats such as: HMO plans, PPO plans, PFFS plans, and special needs plans. Seniors may only enroll in Medicare Advantage plans if they already have both Medicare Part A and Medicare Part B and then only during specially designated enrollment periods. The Medicare enrollment periods change often, so please call us at: 1-(866)-866-7951 to find out when the next open enrollment period starts so you can enroll in this type of Medicare Plan.
Source: medicareplanstoday.com

Medicare Plans for Different Needs

Your health is important. Find a UnitedHealthcare Medicare Advantage plan or Medicare prescription drug plan that may be right for you before Open Enrollment ends December 7. With a Medicare Supplement Insurance plan* you may apply at any time throughout the year.  
Source: uhcmedicaresolutions.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

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

Noridian Healthcare Solutions, LLC

Posted by:  :  Category: Medicare

Part A claims processing covers services provided through hospitals and post-hospital care. Noridian administers Part A for ‘)” onmouseout=”UnTip()”>Jurisdiction F and ‘)” onmouseout=”UnTip()”>Jurisdiction E.
Source: noridianmedicare.com

Electronic Health Records

The Centers for Medicare and Medicaid Services (CMS) established an incentive program using American Recovery and Reinvestment Act (ARRA) funds to encourage eligible providers and hospitals to adopt and use certified Electronic Health Record (EHR) technology. One goal of ARRA is to increase the Meaningful Use of EHR technology among medical providers. 
Source: wa.gov