Medicare Summary Notice Download

Posted by:  :  Category: Medicare

This website is privately owned and all information and advertisements are independent and are not associated with any state exchange or the federal marketplace. Additionally, this website is not associated with, sanctioned by or managed by the federal government, the Centers for Medicare & Medicaid or the Department of Health and Human Services.
Source: medicareenrollment.com

Medicare Part D Drug Benefit

Posted by:  :  Category: Medicare

Namenda IR Availability As of January 2015 the company that produces Namenda will cease production of one version of Namenda (Namenda IR tablets, usually taken twice per day) and it will no longer be available. While supplies of Namenda IR may be available at local pharmacies for a period of time after the company stops distributing it in January, it is anticipated that individuals on this prescription will have to switch to another version of Namenda (XR = extended release once per day capsules). In addition, it is our understanding that a generic version of Namenda IR may be available as early as mid-2015; however, an official date has not been shared and it is not currently listed on the Medicare Part D formularies.
Source: alz.org

Get Medicare Part D Plan Quotes

I am very surprised and pleased with the service Cordell M. gave me. I did not have a strong understanding of my insurance and he was very patient in helping me. He did not rush me, and when I told him I needed to take some time and decide , he most importantly did not try the typical high-pressure close. Overall, I am very pleased. Can’t say enough good things about the way I was treated and talked to by Cordell M. Quite frankly, I expect to sign up through your site with Cordell M. in large part because of the way Cordell M. handled my questions.
Source: ehealthmedicare.com

Medicare Plans & Coverage: Part A, Part B, Part C, Part D

Medicare is a federal insurance program that covers hospitalization expenses as well as doctor and medical expenses. To be eligible for Medicare, one must be an American citizen 65 years or older, or younger with a qualifying disability.
Source: medicareconsumerguide.com

Understanding the Medicare Part D Donut Hole

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

Medicare Part D coverage gap

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

www.Q1Medicare.com Your Source for Medicare Part D Plan Information

Looking for a place to get started? Here is an overview of the Medicare Part D prescription drug and Medicare Advantage programs: Medicare Part D prescription drug plans (or PDPs) provide insurance coverage for your prescription drugs. Medicare Advantage plans (MAs or MA-PDs) provide your Medicare Part A coverage (In-patient and Hospitalization) and your Medicare Part B coverage (Doctors visits and Out-Patient care) – and maybe even Medicare prescription drug coverage. Medicare Part D plans and Medicare Advantage plans are both voluntary programs and you are not required to join a plan. But you may be subject to a late-enrollment penalty if you decide to join a prescription drug plan sometime after your initial enrollment period has ended. Medicare Part D plans and Medicare Advantage plans are regulated by the Centers for Medicare and Medicaid Services (CMS or Medicare) and implemented by private insurance companies (such as Aetna, Humana, and United HealthCare). If you decide to enroll in a Medicare Part D plan or Medicare Advantage plan, you will find that, like any insurance, you pay a monthly premium. The monthly premiums for a Medicare Part D PDP can range from under $20 to over $130 dollars. The monthly premiums for a Medicare Advantage plan with (MA-PD) or without (MA) prescription coverage can range from $0 (no kidding) to well over $100. Medicare Part D and Medicare Advantage plans may have an initial deductible, co-payments or co-insurance, and some Donut Hole (Doughnut Hole) or Gap coverage (you can find more on these topics in our Glossary). When you enroll in a Medicare Part D prescription drug plan or a Medicare Advantage plan that offers prescription coverage, you should find that your prescription medication costs are reduced. The amount of savings depends on the Medicare plan you select. If you wish to learn more, you can click on this link to view all of the Medicare Part D plans in your State
Source: q1medicare.com

Remittance Advice Remark Codes

Posted by:  :  Category: Medicare

The law permits exceptions to the refund requirement in two cases: – If you did not know, and could not have reasonably been expected to know, that we would not pay for this service; or – If you notified the patient in writing before providing the service that you believed that we were likely to deny the service, and the patient signed a statement agreeing to pay for the service. If you come within either exception, or if you believe the carrier was wrong in its determination that we do not pay for this service, you should request appeal of this determination within 30 days of the date of this notice. Your request for review should include any additional information necessary to support your position. If you request an appeal within 30 days of receiving this notice, you may delay refunding the amount to the patient until you receive the results of the review. If the review decision is favorable to you, you do not need to make any refund. If, however, the review is unfavorable, the law specifies that you must make the refund within 15 days of receiving the unfavorable review decision. The law also permits you to request an appeal at any time within 120 days of the date you receive this notice. However, an appeal request that is received more than 30 days after the date of this notice, does not permit you to delay making the refund. Regardless of when a review is requested, the patient will be notified that you have requested one, and will receive a copy of the determination. The patient has received a separate notice of this denial decision. The notice advises that he/she may be entitled to a refund of any amounts paid, if you should have known that we would not pay and did not tell him/her. It also instructs the patient to contact our office if he/she does not hear anything about a refund within 30 days
Source: wpc-edi.com

Claim Adjustment Reason Codes

Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Note: This adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication. (Use only with Group Codes PR or CO depending upon liability) This change effective 3/1/2016: Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Note: This adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication. (Use only with Group Codes PR or CO depending upon liability)
Source: wpc-edi.com

Medical Billing and Coding

51    These are non covered services because this is a pre-existing condition. 52    The referring/prescribing/rendering provider is not eligible to refer/prescribe/order/perform/the service billed. 53    Services by an immediate relative or a member of the same household are not covered. 54    Multiple physicians/assistants are not covered in this case. 55    Claim/service denied because procedure/treatment is deemed experimental/investigational by the payer. 56    Claim/service denied because procedure/treatment has not been deemed “proven to be effective” by the payer. 57    Claim/service denied/reduced because the payer deems the information submitted does not support this level of service, this many services, this length of service, or this dosage. 58    Claim/service denied/reduced because treatment was deemed by the payer to have been rendered in an inappropriate or invalid place of service. 59    Charges are reduced/denied based on multiple surgery rules or concurrent anesthesia rules. 60    Charges for outpatient services with this proximity to inpatient services are not covered. 61    Charges reduced as penalty for failure to obtain second surgical opinion. (Not Medicare). 62    Claim/service denied/reduced for absence of, or exceeded, pre-certification/authorization. 63    *Correction to a prior claim. 64    *Denial reversed per Medical Review. 65    *Procedure code was incorrect. This payment reflects the correct code. 66    Blood Deductible. 67    *Lifetime reserve days. 68    *DRG weight. 69    Day outlier amount. 70    Cost outlier amount. 71    Primary Payer amount. 72    *Coinsurance day. 73    ^Administrative days. 74    Indirect Medical Education Adjustment. 75    Direct Medical Education Adjustment. 76    Disproportionate Share Adjustment. 77    *Covered days. 78    Non Covered days/Room charge adjustment. 79    ^Cost Report days. 80 ^Outlier days. 80    ^Outlier days 81    *Discharges. 82    *PIP days. 83    *Total visits. 84    ^Capital Adjustment. 85    Interest amount. 86    Statutory Adjustment. 87    Transfer amount. 88    Adjustment amount represents collection against receivable created in prior over payment. 89    Professional fees removed from charges. 90    Ingredient cost adjustment. (Not Medicare). 91    Dispensing fee adjustment. (Not Medicare). 92    *Claim Paid in full. 93    No claim level adjustments. 94    Processed in excess of charges. 95    Benefits denied/reduced. Plan procedures not followed. 96    Non covered charges. 97    Payment is included in the allowance for the basic service/procedure. 98    *The hospital must file the Medicare claim for this inpatient non physician service. 99    *Medicare Secondary Payer adjustment amount. 100    Payment made to patient/insured/responsible party.
Source: whatismedicalinsurancebilling.org

Private Health Insurance, Individual, Group, Family Healthcare

Posted by:  :  Category: Medicare

Bupa Travel Insurance is sold by Bupa Insurance Services Limited and underwritten by AIG Europe Limited. Bupa Insurance Services Limited is authorised and regulated by the Financial Conduct Authority (FCA number 312526). AIG Europe Limited is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority (FCA number 202628) and the Prudential Regulation Authority. This information can be checked by visiting the Financial Conduct Authority website (www.fca.org.uk).
Source: co.uk

Bupa: Consultant and Facilities Finder

The information contained on Finder is submitted by consultants, therapists and facilities, and is declared by these third parties to be correct and compliant with the standards and codes of conduct specified by their relevant regulatory body. Bupa cannot guarantee the accuracy of all of the information provided. You can find out more about the data and information on Finder and our website terms of use here.
Source: co.uk

What is the Difference Between Medicare Part A and Medicare Part B?

Posted by:  :  Category: Medicare

At age 65, if you are eligible to receive or are receiving Social Security benefits, you may be automatically be enrolled in Medicare Part A if you paid Medicare taxes while employed. Some Part A recipients are automatically enrolled in Part B as well. However, since you must pay a premium for Medicare Part B benefits, you have an option to refuse this coverage. If you’re not automatically enrolled in Part B and wish to apply, you must first be enrolled in Part A to be eligible. You can sign up for Medicare benefits beginning three months prior to your 65th birthday. The program also conducts a general enrollment period annually during the first three months of the year.
Source: ehow.com

Medicare Part B and FEHB Update (Feedback

The information provided may not cover all aspect of unique or special circumstances, federal regulations, and financial information is subject to change. To ensure the accuracy of this information, contact your benefits coordinator and ask them to review your official personnel file and circumstances concerning this issue. Retirees can contact the OPM retirement center. Our article is not intended nor should it be considered investment advice and our articles and replies are time sensitive. Over time, various dynamic economic factors relied upon as a basis for this article may change. The advice and strategies contained herein may not be suitable for your situation and this service is not affiliated with OPM or any federal entity. You should consult with a financial or human resource professional where appropriate. Neither the publisher or author shall be liable for any loss or any other commercial damages, including but not limited to special, incidental, consequential, or other damages.
Source: fedretire.net

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

COLA wars in Medicare Part B premiums

High-income seniors can talk to their accountant about reducing their taxable income in 2015, but it may not reduce the premium. That’s because there’s normally a 2-year delay, meaning 2016 premiums are based on 2014 modified adjusted gross income, or MAGI. Using your 2015 MAGI for 2016 premiums requires you to file a Form SSA-44 to petition Social Security to adjust your income based on a life-changing event. Social Security lists 8 such events, including work stoppage and work reduction. Your 2015 MAGI is based on your 2015 tax return, so even with a petition, it would be later in 2016 before you could qualify for a reduced premium.
Source: bankrate.com

Enroll for Medicare Part B: Step By Step Guide

Posted by:  :  Category: Medicare

If you are automatically enrolled in Part B, you will receive your card in the mail three months before your benefits are scheduled to begin (except for those with ALS). You do not have to accept Part B. Your card comes with instructions for rejecting coverage. Simply follow them and send the card back if you do not wish to receive Part B coverage. You will pay Part B premiums as long as you keep the card.
Source: mymedicaremedicaid.com

Applying Late For Medicare Part B Enrollment

If you are turning 65 years old, you can enroll in Original Medicare starting three months before you turn 65 years old. The deadline to enroll is three months after you turn 65 years old. If you put off enrolling in Part B in particular, you may have to pay a late enrollment penalty when you do decide to enroll. The penalty is calculated by adding an additional 10% to the monthly premium multiplied by each full 12-month period that the person chose not to enroll in Part B coverage. For instance, if a person chose not to get Part B coverage for three full years, their Part B premium could be increased by 30%.
Source: medicareenrollment.com

Medicare Part B Enrollment

To apply, you can call or visit your local Social Security office or call Social Security at 1-800-772-1213. You can apply online (using the Internet) if you meet certain rules. To apply online, visit www.socialsecurity.gov. You must answer a series of questions that will tell if you can apply online. For example, you must be at least 61 years and 9 months old; plan to start receiving Social Security retirement benefits within the next 4 months; live in the United States or one of its territories/commonwealths; agree to get your Social Security benefits by direct deposit to your bank or other financial institution. You must answer some other questions as well.
Source: medicaresupplementshop.com

Medicare Part B Enrollment Penalties

If you’re actively working and are covered by employer- or union-provided health insurance, you generally are able to opt out of Part B coverage for as long as that coverage remains in effect. You won’t be penalized for delaying your Part B coverage for this reason, but you should discuss the matter both with a benefits specialist at work and with a specialist at Social Security, who will want to talk to you if you opt out of Part B coverage. If you have this alternate medical coverage, you’ll be entitled to a special enrollment period, or SEP, of eight months following the date you lose that employer-provided coverage.
Source: ehow.com

Urgent Care is "In Network" Aetna, HIP, GHI, Emblem, United, Oxford, Empire, 1199, Cigna, Blue Cross Blue Shield, Health Republic, Metroplus

Posted by:  :  Category: Medicare

Statcare accepts all major Insurances.  Statcare is also designated as an in-network urgent care facility of choice with most insurance plans. Our walk-in clinic accepts all insurance except Medicaid, Fidelis Medicaid, HealthPlus Medicaid.
Source: statcarewalkin.com

EmblemHealth: Health Insurance Plans in NY

Quality health care coverage at little or no cost. EmblemHealth is happy to offer New York state-sponsored Medicaid Managed Care, Enhanced Care Plus (HARP), Child Health Plus and Managed Long Term Care health insurance plans to eligible individuals and families throughout New York City, Long Island and Westchester County.
Source: emblemhealth.com

EmblemHealth: Medicare Coverage

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 copayments/coinsurance may change on January 1 of each year. You must continue to pay your Medicare part B premium. This information is available for free in other languages. Please call our customer service number at 1-877-344-7364 (HMO Customer Service) or 1-866-557-7300 (PPO Customer Service), TTY/TDD users call 711, Monday through Sunday, from 8 am to 8 pm. Esta información está disponible gratis en otros idiomas. Por favor llame a nuestro número de servicios de atención al cliente al 1-877-344-7364 (HMO Servicios de atención al cliente) o 1-866-557-7300 (PPO Servicios de atención al cliente) (TTY/TDD: 711) de 8 am a 8 pm, los siete días de la semana.
Source: emblemhealth.com

Location of Medicare Offices

Posted by:  :  Category: Medicare

If you are seeking office opening hours, the Department of Human Services Service Centre locator contains information updated weekly, a search function and maps. Please visit the Service Centre locator here: humanservices.findnearest.com.au
Source: gov.au

How to Locate a Medicare Office

The Social Security Administration handles the U.S. health care program known as Medicare. Medicare helps senior citizens over 65 years of age get the health care and medical supplies they need. According to the Social Security Administration website, ssa.gov, most Medicare related tasks, such as applying for coverage, can be completed online or over the phone. However, there are a few crucial tasks that must be completed in person. Medicare offices are maintained in local Social Security Offices, which can be located through the Social Security Administration in two ways.
Source: ehow.com

Medicare for All: Regional Offices

Please note: The regional map has telephone numbers with it. Those telephone numbers are for the current Medicare. People who answer those phone numbers are only paid to help with the CURRENT Medicare, not to help explain or discuss Improved Medicare for All.
Source: medicareforall.org

Location of Medicare Offices

The data below is provided for application developers or those wishing to reuse the data for other purposes. It is important that application developers keep the data up to date with the current version available on this website.
Source: gov.au

Orange County, California

Medicare is a federally funded health insurance program for people age 65 or older. Certain people younger than age 65 may also qualify. To find out more about Medicare and how it can help you, clink on any of the links below.
Source: ocgov.com

The United States Social Security Administration

Posted by:  :  Category: Medicare

Social Security needs your help. We are asking for responses to an Advanced Notice of Proposed Rulemaking on how we should modernize our vocational rules, which we first published in 1978. These are the rules…
Source: ssa.gov

Apply for Social Security Benefits

If you need to report a death or apply for survivors’ benefits, call 1-800-772-1213 (TTY 1-800-325-0778). You can speak to a Social Security representative between 7 AM and 7 PM Monday through Friday. You can also contact your local Social Security office.
Source: ssa.gov

When and How to Apply for Medicare

Posted by:  :  Category: Medicare

You will automatically receive a package which contains important information about the decisions you need to make. For example, although eligible, you do not have to enroll in Part B, which requires you to pay a monthly premium. You need to take the time to learn about Medicare Part B to determine if you should sign up; if you don’t sign up initially it may cost you more to sign up later.
Source: about.com

How to Apply for Medicare

When you receive your Medicare card after enrolling in part A, you will also get an Initial Enrollment Questionnaire (IEQ). This brief survey asks about other health insurance you currently have (such as coverage through your employer or spouse’s employer), treatments you have received under liability insurance, or workers’ compensation benefits you are entitled to. You may return this paper copy of the IEQ through the mail, complete the questionnaire online at MyMedicare.gov, or call the Coordination of Benefits Contractor at 1-800-999-1118 to complete it over the phone. You may also want to complete an Authorization Form which will permit Medicare to share personal health information about you with those you specify in writing (for instance, family members). Call 1-800-MEDICARE to ask that this form be mailed to you, or fill it out online at http://www.medicare.gov/MedicareOnlineForms/ . MyMedicare.gov is a helpful and secure online service which allows you to keep track of your Medicare information and benefits; visit the site to sign up for its services after receiving your Medicare card.
Source: medicaresolutions.com

How To Apply For Medicare

Medicare is available for people age 65 or older, to younger people with disabilities, and people with End-Stage Renal Disease (ESRD or permanent kidney failure). Anyone currently receiving benefits from the Social Security Administration (SSA) or the Railroad Retirement Board (RRB) is automatically entitled to Medicare Part A (Hospital Insurance) and Part B (Medical Insurance). In these instances, coverage begins the first day of the month that you turn 65.
Source: ehealthinsurance.com

Medicare Card: Applying for a New Medicare Card and Replacing a Lost Medicare Card

Once you have enrolled in the Medicare program, your red, white, and blue Medicare card should arrive in the mail about three months before your coverage begins. For U.S. citizens and legal permanent residents approaching their 65th birthday, enrollment in Medicare could be automatic. This happens if you receive Social Security Administration (SSA) benefits or Railroad Retirement Board (RRB) benefits. In these cases, you are enrolled in Medicare Part A beginning on the first day of the month in which you turn 65, and your card should arrive three months prior to this.
Source: planprescriber.com