How to Find a Dentist That Accepts Medicaid

Posted by:  :  Category: Medicare

According to a report published early in 2015 by the Center for Health Care Strategies, 47 states offer some form of Medicaid dental coverage, but 15 of those limit it to emergency care and only 16 offer comprehensive coverage, which includes regular check-ups. Participation by individual providers is always optional. If your state Medicaid program includes dentistry, and you have a local dentist in mind, contact their office directly to inquire whether or not they will accept Medicaid insurance. If they don’t, they may be able to refer you to another dentist who will. If you have trouble scheduling an appointment, contact the state Medicaid agency for assistance. Bring your insurance card to the dentist’s office and be prepared to complete some paperwork, if it’s your first visit.
Source: ehow.com

Costs in the coverage gap

Posted by:  :  Category: Medicare

Mrs. Anderson reaches the coverage gap in her Medicare drug plan. She goes to her pharmacy to fill a prescription for a covered brand-name drug. The price for the drug is $60, and there’s a $2 dispensing fee that gets added to the cost. Mrs. Anderson will pay 45% of the plan’s cost for the drug ($60 x .45 = $27) plus 45% of the cost of the dispensing fee ($2 x .45 = $0.90), or a total of $27.90, for her prescription. $57.90 will be counted as out-of-pocket spending and will help Mrs. Anderson get out of the coverage gap because both the amount that Mrs. Anderson pays ($27.90) plus the manufacturer discount payment ($30.00) count as out-of-pocket spending. The remaining $4.10, which is 5% of the drug cost and 55% of the dispensing fee paid by the drug plan, isn’t counted toward Mrs. Anderson’s out-of-pocket spending.
Source: medicare.gov

Medicare Part D Donut Hole – Prescription Drug Coverage Gap

Most Medicare Part D plans have a coverage gap, sometimes called the Medicare donut hole. This means that after you and your Medicare drug plan have spent a certain amount of money for covered prescription drugs, you then have to pay all costs out-of-pocket for the drugs, up to a certain limit. The yearly deductible, co-insurance, or co-payments, and what you pay while in the coverage gap, all count toward this out-of-pocket limit. The limit doesn’t include the drug plan’s premium.
Source: ehealthmedicare.com

Medicare Information, Help, and Plan Enrollment

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

Medicare 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

Medicare Part D Plans: Prescription Drug Coverage

Part D is prescription drug coverage insurance that is provided by private companies approved by Medicare. You need to enroll when you first become eligible to keep from paying a penalty cost later. Part D was designed to help people with Medicare to lower their prescription drug costs and to protect against future costs. A prescription drug plan will also enable you to have greater access to medically necessary drugs.
Source: medicareconsumerguide.com

Medicare Drug Coverage Limits (The Donut Hole)

While in this stage in 2016 you are responsible for 58% of your plan’s cost for generic (non-brand name) Part D medications and your plan pays the remaining 42%. For brand name drugs you will pay 45% of your plan’s cost for the medications, the drug manufacturer will pay another 50% and your plan will pay the remaining 5%. You will remain in the Donut Hole until you reach the out-of-pocket maximum of $4,850. It is important to understand that while in the Donut hole the 45% you pay and the 50% the drug manufacturer pays for brand name drugs, in addition to 65% you pay for generic drugs all count towards the out-of-pocket maximum of $4,850. Once you reach the out-of-pocket maximum of $4,850 you enter the Catastrophic Coverage Stage.
Source: tuftsmedicarepreferred.org

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

How Part D works with other insurance

While prescription drug coverage is an essential health benefit, prescription drug coverage in a Marketplace or SHOP plan isn’t required to be at least as good as Medicare Part D coverage (creditable). However, all private insurers offering prescription drug coverage, including Marketplace and SHOP plans, are required to determine if their prescription drug coverage is creditable each year and let you know in writing.
Source: medicare.gov

Medicare Plan Finder for Health, Prescription Drug and Medigap plans

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

Medicare 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

Need help finding the 2016 Medicare Part D PDP Plan that best meets your needs?

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Source: q1medicare.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

Browse Any 2016 Medicare Part D or Medicare Advantage Plan Formulary

Posted by:  :  Category: Medicare

- 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

Coventry Medicare: Formulary (Drug List)

A formulary is a list of prescription medications that are covered by your plan and are available in a booklet format and an online searchable tool.  A pharmacy directory is a listing of pharmacies in your plan’s network, including preferred retail pharmacies, mail-order, home infusion and long-term care pharmacies. 
Source: coventryhealthcare.com

Medicare Part D Formulary, List of PDP Drugs

Medicare Part B covered drugs include a limited number of prescription drugs such as those you get in a hospital outpatient department under certain circumstances, injected drugs you get in a doctor’s office, certain oral cancer drugs, and drugs used with some types of durable medical equipment (like a nebulizer or infusion pump). Certain diabetic supplies, such as: monitors, test strips and lancets are covered under Part B.  Medicare Part B drugs include, but are not limited to, the following types of drugs:
Source: coventryhealthcare.com

Medicare Part D Formulary Drug List FAQs

We may make certain changes to our list of covered drugs throughout the year. Changes in the drug list may affect which drugs are covered and how much you will pay when filling your prescription. If we remove drugs from our drug list, or add prior authorization, quantity limits and/or step therapy restrictions on a drug or move a drug to a higher cost cost-sharing tier, we will post a notice on this site at least 60 days before the change becomes effective. In addition, you will be notified on your Explanation of Benefits (EOB) mailing, if you are taking the impacted drug.
Source: cigna.com

Covered and Excluded Drugs in Medicare Part D Drug Formulary

This list of covered prescription drugs is called a “formulary,” and it contains all the drugs that the Medicare Prescription Drug plan prefers you to buy. Generally, a plan covers drugs that cost less at a higher level, meaning you pay less out of pocket. Thus, it’s always in your interest to ask your doctor to prescribe drugs that are on your Medicare Prescription Drug Plan’s formulary. Usually, generic drugs are the least expensive.
Source: ehealthmedicare.com

How to Reform Medicare: First Stage to Fix the Current Program

Posted by:  :  Category: Medicare

[5]The significant differences in official long-term projections, including projections of the program’s unfunded liability, reflect the differences in agency assumptions, particularly about the likelihood of the continuation of current law. The Medicare Trustees and the Congressional Budget Office (CBO) are required to make projections under current law, which assumes, for example, that the large Medicare Part A payment reductions are sustainable and that the projected 29.4 percent reduction in Medicare physician payment will be implemented in 2012. The Office of the Actuary in the Centers for Medicare and Medicaid Services (CMS) makes projections based on the premise that key elements of current law are simply “unworkable.” See John D. Shatto and M. Kent Clemens, “Projected Medicare Expenditures Under an Illustrative Scenario with Alternative Payment Updates to Medicare Providers,” Centers for Medicare and Medicaid Services, Office of the Actuary, May 13, 2011, at https://www.cms.gov/ReportsTrustFunds/downloads/2010TRAlternativeScenario.pdf (September 19, 2011).
Source: heritage.org

Medicare Supplemental Insurance by 1

 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

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 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 and Medicaid: What's the Difference?

Posted by:  :  Category: Medicare

Costs to Consumer: You must pay a yearly deductible for both Medicare Part A and Part B, and make hefty copayments for extended hospital stays. Under Part B, you must pay the 20% of doctors’ bills Medicare does not pay, and sometimes up to 15% more. Part B also charges a monthly premium. Under Part D, you must pay a monthly premium, a deductible, copayments, and all of your prescription drug costs over a certain yearly amount and up to a ceiling amount, unless you qualify for a low-income subsidy.
Source: nolo.com

Medicare Guidelines Explained For The Speech

When you submit your credit card and other sensitive information to NorthernSpeech.com, rest assured that the transaction is secure. In fact, shopping online at NSS is as safe as using your credit card at a restaurant or department store. Our servers use Secure Sockets Layer (SSL), one of the most robust encryption platforms available. SSL technology works with Netscape Navigator (versions 2.0 and above), Microsoft Internet Explorer (version 3.0 and above), AOL (AOL 3.0 and above), Firefox, Safari and Opera. This technology encrypts your private information from the moment you enter it until your transaction is processed, and your personal information will not be saved on a public server–thus safeguarding your personal information and guaranteeing privacy.
Source: northernspeech.com

How Much of the Medicare Spending Slowdown Can be Explained? Insights and Analysis from 2014

The slow growth in Medicare spending has also led to relatively modest increases in Medicare premiums and cost sharing, which are indexed to rise with program costs. For example, Medicare Part B premiums, which are pegged to growth in Part B spending, were unchanged between 2013 and 2014 and will be the same in 2015 as in the previous two years. And the Medicare Trustees project that the Independent Payment Advisory Board (IPAB)—a controversial but not yet appointed or convened independent entity which was authorized by the ACA as a spending backstop—will not be required to issue recommendations for Medicare savings until 2022, due to relatively low projected spending trends.
Source: kff.org

Oregon Health, Dental, Medicare Supplement and Medicare Advantage Plans

Posted by:  :  Category: Medicare

CDA Insurance LLC offers several full lines of Oregon Health Insurance and related insurance coverage. We compare the policies for you, so you only need to look at 2 or 3 plans which meet your needs, instead of 20 to find the one that might. Information and applications (online, and print & mail-in) are available for individual, group, short term medical, travel, HSA, Medicare Supplement and Medicare Advantage plans. We help you get the best coverage, the right plan, and the lowest cost. Our service area includes Portland, Beaverton, Hillsboro, Forest Grove, Tualatin, Lake Oswego, Gresham, Salem, Eugene, Medford, Grants Pass, Klamath Falls and the rest of the State of Oregon. You can view rate and benefit information from HealthNet, Kaiser, LifeWise, Moda Health, PacificSource, Providence and Regence. You can also use our online quoting system and get your answers immediately.
Source: oregon-health-insurance.com

Oregon Nursing Homes Directory; Free Guide to Oregon Long Term Care Facilities

137 Oregon Nursing Homes and rehabilitation, convalescent facilities listed in the Compare Nursing Homes database at www. medicare.gov. We do not sell, endorse or recommend any service, product or particular facility.
Source: dibbern.com

UnitedHealthcare Medigap Plans in Oregon

A 65-year-old non-tobacoo user can buy Plan A for a monthly premium of $59.50, the lowest cost for Plan A among insurance providers in Oregon. Plan B is offered at the comparatively low premium of $96.60 per month, and Plan C at $111.30 per month. Plan C Select, which requires you to choose health care providers from a network, is offered for $90.65 per month and is the only Plan C Select offered by any insurance company in Oregon. Plan F is on the market for a monthly premium of $112, while Plan F Select is offered for $91 per month. Like the Plan C Select, this plan is a managed care policy and is the only Plan F Select available in Oregon. UnitedHealthcare offers Plan K for a premium of $70.35 per month, Plan L for $60.90 per month and Plan N for $70.35 per month. UnitedHealthcare’s prices for plans L and N are the lowest rates for those policies in Oregon.
Source: emedicaresupplements.com

Noridian Healthcare Solutions, LLC

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

Medicare Advantage 2015 Data Spotlight: Overview of Plan Changes

Posted by:  :  Category: Medicare

When SNPs were authorized, there were few requirements beyond those otherwise required of other Medicare Advantage plans. The Medicare Improvements for Patients and Providers Act (MIPPA) of 2008 established additional requirements for SNPs, including requiring all SNPs to provide a care management plan to document how care would be provided for enrollees and requiring C-SNPs to limit enrollment to beneficiaries with specific diagnoses or conditions. As a result of the new MIPPA requirements, the number of SNPs declined in 2010. The ACA required D-SNPs to have a contract with the Medicaid agency for every state in which the plan operates, beginning in 2013. Additionally, in 2013, joint federal-state financial alignment demonstrations to improve the coordination of Medicare and Medicaid for dually eligible beneficiaries began to enroll beneficiaries. Today, financial alignment demonstrations are underway in 12 states: California, Colorado, Illinois, Massachusetts, Michigan, Minnesota, New York, Ohio, South Carolina, Texas, Virginia, and Washington. The financial alignment demonstrations could influence the availability of D-SNPs in these states, either increasing or decreasing the availability of SNPs, depending on the design of the demonstration.
Source: kff.org

Florida Blue Medicare Advantage Plans for 2016

Are you a Florida senior citizen who is trying to maximize your Medicare benefits? Just as each senior citizen has her own unique needs and preferences, insurers offer a variety of different ways to enjoy these hard-earned health benefits and even help you plan for medical expenses that original Medicare does not completely cover. At Secure Health Options, we want to help all Floridians find the right plan that assures them of convenient and affordable access to the best medical providers. You can request information on Medicare Advantage plans and Florida Medicare supplemental insurance in your own local area by entering your home ZIP code in the box at the top of this page. If you have questions or would like help signing up, be sure to give us a call.
Source: floridamedicareadvantageplans.com

Compare Medicare Advantage Plans in 2015

The Kaiser Family Foundation also says that plans and costs are bound to differ wildly in different areas of the country or even regions of the same state. Available plans and premiums can differ when you cross a ZIP code boundary or into a new county. The key is to find different options in your local area and select the one that suits your needs and budget the best. Your own right choice will depend upon the premium, options available in your town or city, the network of medical providers, covered benefits and benefit amounts, and the potential for out of pocket costs.
Source: medicareadvantageplans2015.net

The Best Rated Medicare Advantage Plans

Medicare beneficiaries can choose original Medicare fee-for-service (Part A and Part B) or select one of the health plans offered by private insurers under the Medicare Advantage program. To enable beneficiaries to make an informed choice on private plans, the federal Medicare agency collects information on the plans, including beneficiary satisfaction surveys and objective measures such as patient outcomes data. This information is compiled, analyzed and converted into a plan rating ranging from a low of one star to a high of five stars.
Source: ehow.com

Disability Planner: Medicare Coverage If You’re Disabled

Posted by:  :  Category: Medicare

Everyone with Medicare also has access to prescription drug coverage (Part D) that helps pay for medications doctors prescribe for treatment. For more information on the enrollment periods for Part D, we recommend you read Medicare’s "How to get drug coverage" page.
Source: ssa.gov

Does Medicare or Medicaid Come with Disability?

Do you get Medicare coverage if you were approved for SSI? Claimants who are approved for SSI only typically receive Medicaid coverage in most states. And like SSI, Medicaid is subject to income and asset limitations. Medicaid is a needs-based, state- and county-administered program that provides for a number of doctor visits and prescriptions each month, as well as nursing home care under certain conditions. Can you ever get Medicare if you get SSI? Medicare coverage for SSI recipients does not occur until an individual reaches the age of 65 if they were only entitled to receive monthly SSI disability benefits. At the age of 65, these individuals are able to file an uninsured Medicare claim, which saves the state they reside in the cost of Medicaid coverage. Basically, the state pays the medical premiums for an uninsured individual to be in Medicare so that their costs in health coverage provided through Medicaid goes down. 
Source: disabilitysecrets.com

Individuals with Disabilities

Many individuals who qualify for Medicaid based on disability also receive cash assistance under the Supplemental Security Income (SSI) program. In almost all states, SSI eligibility automatically qualifies an individual for Medicaid coverage. However, some states use more restrictive eligibility criteria than those used by the SSI program. This means that in those states (commonly referred to as 209(b) states) receipt of SSI does not guarantee eligibility for Medicaid. Individuals not receiving SSI but seeking coverage based on disability must demonstrate that they have an impairment that prevents them from performing "substantial gainful activity" for at least one year. Once a disability determination is made, the individual must then undergo an asset test and meet specific income requirements in order to be considered for Medicaid eligibility.
Source: medicaid.gov

Costs in the coverage gap

Posted by:  :  Category: Medicare

Mrs. Anderson reaches the coverage gap in her Medicare drug plan. She goes to her pharmacy to fill a prescription for a covered brand-name drug. The price for the drug is $60, and there’s a $2 dispensing fee that gets added to the cost. Mrs. Anderson will pay 45% of the plan’s cost for the drug ($60 x .45 = $27) plus 45% of the cost of the dispensing fee ($2 x .45 = $0.90), or a total of $27.90, for her prescription. $57.90 will be counted as out-of-pocket spending and will help Mrs. Anderson get out of the coverage gap because both the amount that Mrs. Anderson pays ($27.90) plus the manufacturer discount payment ($30.00) count as out-of-pocket spending. The remaining $4.10, which is 5% of the drug cost and 55% of the dispensing fee paid by the drug plan, isn’t counted toward Mrs. Anderson’s out-of-pocket spending.
Source: medicare.gov

Medicare Part D Donut Hole – Prescription Drug Coverage Gap

Most Medicare Part D plans have a coverage gap, sometimes called the Medicare donut hole. This means that after you and your Medicare drug plan have spent a certain amount of money for covered prescription drugs, you then have to pay all costs out-of-pocket for the drugs, up to a certain limit. The yearly deductible, co-insurance, or co-payments, and what you pay while in the coverage gap, all count toward this out-of-pocket limit. The limit doesn’t include the drug plan’s premium.
Source: ehealthmedicare.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

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 Part D Plans: Prescription Drug Coverage

Part D is prescription drug coverage insurance that is provided by private companies approved by Medicare. You need to enroll when you first become eligible to keep from paying a penalty cost later. Part D was designed to help people with Medicare to lower their prescription drug costs and to protect against future costs. A prescription drug plan will also enable you to have greater access to medically necessary drugs.
Source: medicareconsumerguide.com