2016 Massachusetts Medicare Part D Prescription Drug Plan Highlights www.Q1Medicare.com

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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

Medicare.gov: the official U.S. government site for Medicare

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

Total Number of Medicare Beneficiaries

Data indicators about private plans participating in the Medicare Advantage program and the Medicare prescription drug program. The Medicare Health and Prescription Drug Plan Tracker enables users to monitor trends in enrollment, market penetration and other topics for Medicare Advantage plans since 1999 and stand-alone Medicare drug plans since 2006 by state, county and other sub-state geographies.
Source: kff.org

Best Medicare Part D Plans

To find the best planS(f0dlie2v0j1fu2bc3u5dwyzy))/questions/home.aspx?AspxAutoDetectCookieSupport=1) for you, go to Medicare.gov and click the tab labeled “Find Health and Drug Plans.” You’ll answer a few questions about your Medicare status and then create a list of the drugs you take. You can come back without filling in the drug list again if you take note of the drug list identification number and date (called the password date). Specify two local retail pharmacies, and in short order, you have a list of Part D insurance plans to choose from — sometimes dozens of them.
Source: ehow.com

Medicare Fraud Reporting Center

Posted by:  :  Category: Medicare

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

Help fight Medicare fraud

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

Report Fraud, Waste or Abuse

I wish to remain Confidential. You may contact me for additional information, but please keep my name confidential and do not share it outside of the Office of the Inspector General. Our policy is to honor requests for confidentiality and not to release any data that would identify such individuals unless required to do so by order of law (e.g., court order/subpoena). Please fill out the contact form below.
Source: socialsecurity.gov

Getting outpatient therapy? Be sure you know Medicare’s limits

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You may qualify to get an exception so that Medicare will continue to pay its share for your services after you reach the therapy cap limits. Your therapist must document your need for medically-necessary services in your medical record, and your therapist’s billing office must indicate on your claim for services above the therapy cap that your outpatient therapy services are medically necessary.
Source: medicare.gov

Oklahoma Medicare Supplement Plans - Compare Oklahoma Medigap Plans

Posted by:  :  Category: Medicare

There are certain times that Oklahoma Medicare beneficiaries have guaranteed issue rights for Medigap plans. During these times, insurance companies must sell policies to beneficiaries, must cover any pre-existing conditions, and are unable to charge more for a policy because of health problems. The most common guaranteed issue rights period is during a beneficiary’s Medigap Open Enrollment Period, which lasts six months and begins on the first day of the month that a beneficiary is both 65 or older and enrolled in Medicare Part B. During this enrollment period, insurance companies cannot use medical underwriting to deny policy coverage. Other special circumstances qualify a beneficiary for a guaranteed issue rights period, such as:
Source: planprescriber.com

Oklahoma Insurance Department

The Senior Health Insurance Counseling Program (SHIP) is a non-profit organization helping to inform the public about Medicare and other senior health insurance issues. This division provides accurate and objective counseling, assistance, and advocacy relating to Medicare, Medicaid, Medicare supplements, Medicare Advantage, long-term care, and other related health coverage plans for Medicare beneficiaries, their representatives, or persons soon to be eligible for Medicare.
Source: ok.gov

Medicare Supplement Insurance

* Plan F also has an option called a high-deductible Plan F. This high-deductible plan pays the same or offers the same benefits as Plan F after one has paid a calendar year $2,180 deductible. Benefits from high-deductible Plan F will not begin until out-of-pocket expenses are $2,180. Out-of-pocket expenses for this deductible are expenses that would ordinarily be paid by the policy. These expenses include the Medicare deductibles for Part A and Part B, but do not include the plan’s separate foreign travel emergency deductible. ** Hospital benefits must be provided by facilities participating with Medicare. Payments are limited to the reasonable charge as determined by Medicare. *** After 90 days of hospitalization, Medicare benefits are paid from a one-time lifetime reserve of 60 additional days (days 91-150) which are not renewable each benefit period. See your Outline of Coverage for details and limitations of these benefits.
Source: bcbsok.com

2016 Oklahoma 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

Oklahoma City VA Medical Center

Attention A T users. To access the menus on this page please perform the following steps. 1. Please switch auto forms mode to off. 2. Hit enter to expand a main menu option (Health, Benefits, etc). 3. To enter and activate the submenu links, hit the down arrow. You will now be able to tab or arrow up or down through the submenu options to access/activate the submenu links.
Source: va.gov

Medicare Supplement Plan F

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* A benefit period begins on the first day you receive services as an inpatient in a hospital and ends after you have been out of the hospital and have not received skilled care in any other facility for 60 days in a row. ** NOTICE: When your Medicare Part A hospital benefits are exhausted, the insurer stands in the place of Medicare and will pay whatever amount Medicare would have paid for up to an additional 365 days as provided in the policy’s “Core Benefits.” During this time the hospital is prohibited from billing you for the balance based on any difference between its billed charges and the amount Medicare would have paid.
Source: bcbsil.com

Medicare Supplement Plan F

Medicare Supplement Plan F may offer expansive coverage, but it does not cover everything. Under Plan F, beneficiaries are still required to pay their Medicare Part B premium payments each month. Additionally, it is possible to have Medicare Part A without a monthly premium if the beneficiary has worked and paid Social Security taxes for at least 40 calendar quarters (10 years). Otherwise, a monthly premium for Part A coverage is also required. These costs are not covered under Medicare Supplement Plan F.
Source: ehealthinsurance.com

Medicare.gov: the official U.S. government site for Medicare

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

Find The Best Rate For Medicare Plan F With MediGap Advisors

"Dawn was very responsive, knowledgeable, and helpful! The process was pleasant and painless. As for why we chose MediGap Advisors, I found you on the internet and after talking with Dawn, the decision was easy. You should know that I am an insurance agent, but do not offer Med Sups. I do have several friends who do, but I chose to work through Dawn anyway. I think that should give you some comfort that you have a solid agent representing your company."
Source: medigapadvisors.com

Medicare Home Medical Equipment Qualifications

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The elements that are addressed will depend on the diagnoses that are responsible for the mobility deficit.  For example, for patients with COPD, heart failure, or arthritis, the major emphasis will be on symptoms and history of the progression of their condition rather than on the physical examination.  Functional assessment is important for all patients. Physicians shall also provide reports of pertinent laboratory tests, x-rays, and/or other diagnostic tests (e.g., pulmonary function tests, cardiac stress test, electromyogram, etc.) performed in the course of management of the patient. Physicians shall document the evaluation in a detailed narrative note in their charts in the format that they use for other entries.  The note must clearly indicate that a major reason for the visit was a mobility evaluation.  Physician Fee for Face-To-Face evaluation Due to the MMA requirement that the physician or treating practitioner create a written prescription and a regulatory requirement that the physician or treating practitioner prepare pertinent parts of the medical record for submission to the durable medical equipment supplier, the Centers for Medicare & Medicaid Services (CMS) has established the new G Code (G0372) to recognize additional physician services and resources required to establish and document the need for a PMD. CMS believes that the typical amount of additional physician services and resources involved is equivalent to the physician fee schedule relative values established for a level 1 office visit for an established patient (Current Procedural Terminology (CPT) code 99211). The payment amount for such a visit is $21.60 Code G0372 indicates that: – All of the information necessary to document the PMD prescription is included in the medical record. – The prescription, along with the supporting documentation, has been received by the PMD supplier within 45 days after the face-to-face examination. Effective October 25, 2005, G0372, will be used to recognize additional physician services and resources required to establish and document the need for the PMD, and are  added to the Medicare physician fee schedule.
Source: viennamedical.com

Original Medicare (Part A and B) Eligibility and Enrollment

To be eligible for premium-free Part A, an individual must be entitled to receive Medicare based on their own earnings or those of a spouse, parent, or child. To receive premium-free Part A, the worker must have a specified number of quarters of coverage (QCs) and file an application for Social Security or Railroad Retirement Board (RRB) benefits. The exact number of QCs required is dependent on whether the person is filing for Part A on the basis of age, disability, or End Stage Renal Disease (ESRD). QCs are earned through payment of payroll taxes under the Federal Insurance Contributions Act (FICA) during the person’s working years. Most individuals pay the full FICA tax so the QCs they earn can be used to meet the requirements for both monthly Social Security benefits and premium-free Part A.
Source: cms.gov

Who can join a Medicare Advantage Plan?

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Source: medicare.gov

Medicare.gov: the official U.S. government site for Medicare

Posted by:  :  Category: Medicare

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

Coventry Medicare: Advantra (HMO/PPO)

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

Iowa Medicare Supplement Plans

Medicare Part A provides coverage for inpatient hospital care, skilled nursing facility (SNF), blood services, and hospice care. Medicare Part B provides coverage for medical services, including medical expenses either in or our of the hospital, outpatient hospital treatment, blood services, clinical laboratory services (diagnostic tests), home health care (approved medically necessary skilled care services and supplies), and durable medical equipment like wheelchairs, walkers, etc. Medicare Part B also covers some preventive care services. Medicare Part C is actually a replacement of Medicare and is known as the “Medicare Advantage” plan, or a “Medicare Replacement” policy. Medicare Part D is coverage for prescription Medications.
Source: medicaresupplementsolutions.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

California Medicare Plans Benefits And Premium Information Publications And Forms

Posted by:  :  Category: Medicare

We provide access to plan benefit guides, forms and publications along with general and specific insurance information for all California beneficiaries. You will find many details and links listed on this site. You may also make an instant request for materials or call our Toll-Free Medicare insurance helpline which is 800-458-7805 Need Help Fast?? Click Here  You should seek the advice of an insurance professional if you are not sure how each insurance plan works. You should not have to pay for the consultation since insurance brokers are usually paid directly from insurance companies. A good Broker or Agent should give you a non-biased opinion of many plans and answer your specific questions. We have a staff of insurance professionals available to answer any of your questions and we will provide you with specific enrollment materials or Medicare Plan summary of benefits by request. 2012 Medicare And You Hand Book Please feel free to use any of our resources and don’t hesitate to call our helpline at any time. We are happy to answer questions and provide you with any forms or publications that you may need. Individual Non Medicare Insurance From AETNA For Those Under 65 You may download anything you would like from this site for free or you may also visit our other site at www.todaysmedicare.com check back often. This site will be updated regularly. Check back often for updated information or call our Toll Free Helpline 1-800-683-6729
Source: californiamedicare.org

Medicare Supplement Plans (Medigap) in California

California is one of the few states that have state-specific guidelines to make it easier to switch Medicare Supplement plans outside of the Medigap Open Enrollment Period. Under the California “birthday rule,” a Medicare beneficiary who already has a Medicare Supplement plan can switch to a different Medicare Supplement plan for a period of 30 days following his or her birthday each year. During this time, Medicare beneficiaries in California are allowed to change Medigap plans as long as their new plan provides equal or lesser coverage than the Medicare Supplement plan in which they are currently enrolled. This means that if you’re a California resident enrolled in Medicare Supplement Plan A, you wouldn’t be able to enroll in Medicare Supplement Plan F (the most comprehensive plan) because Plan F provides greater coverage that Plan A. Also note that as a California resident, you may technically change your Medicare Supplement plan at any time during the year, but you wouldn’t be subject to medical underwriting during the annual “birthday rule” enrollment period.
Source: planprescriber.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

New to Medicare? My California Medicare can help!

Medical Insurance (Part B) – For those new to Medicare, Medicare Part B pays for doctor’s services and other medical services and supplies that are not covered by hospital insurance. Medicare pays for 80% of the “reasonable charge” for Part B covered services after you have met your yearly deductible and you pay for the remaining 20%. Those new to Medicare should be aware Part B has a monthly premium that depends upon your income. For people who are new to Medicare, enrolling in Part B is a choice. You can sign up for Part B anytime during a seven-month period that starts three months before you reach age 65. However, keep in mind that you may incur a penalty if you do not buy Part B when you are first eligible.
Source: mycaliforniamedicare.net

Medigap Insurance in California

"Thanks again for your help – I had absolutely no idea how to get this done when I got up this morning. You’ve made it remarkably easier than I expected. I hope you’re not stuck at the office all night…"
Source: californiamedigap.com

Medicare.gov: the official U.S. government site for Medicare

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

Social Security Disability Medicare Retirement Laid Bare

, and the SSI program. We provide information on applying for benefits, appealing denials, understanding Medicare, finding a Disability Lawyer, and making the most of your SSI benefits. The information is presented in plain English, without technical jargon.
Source: socialsecuritylaidbare.com

Medicare Disability Coverage For Those Under 65

Commenting in an essay The Long Wait: The Impact of Delaying Medicare Coverage for People with Disabilities, Stuart Guterman of the Commonwealth Fund stated that, At a particularly difficult point in their lives, disabled individuals must wait two years before they are eligible to begin receiving Medicare benefits—a delay that can block access to needed care and relief from financial pressures.
Source: about.com

How to Apply for Medicare With a Disability

You must qualify for and receive Social Security disability benefits before you can receive Medicare. If your disability does not qualify you for SSDI, it doesn’t qualify you for Medicare, either. You can apply for Social Security disability benefits online. It’s a good idea to go through the Social Security Administration’s checklist, which is also online, to make sure you have everything you will need to apply. If you are approved for Social Security disability benefits, your Medicare benefits will begin automatically when you are eligible for them. You won’t need to fill out a special application for them.
Source: ehow.com

Medicare and Social Security Disability Benefits

You can get financial help from Social Security and Medicare if you’re permanently disabled or if you have Lou Gehrig’s disease or kidney failure. To be considered “permanently disabled,” your doctor must confirm that you are unable to work for at least 12 consecutive months. Being “unable to work” means you cannot perform your job functions because of the disability, and you cannot find a new line of work because of age, education, or impairment. You must follow your doctor’s prescribed treatment plan to continue to qualify. It’s a good idea to keep up-to-date medical records.
Source: planprescriber.com

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

Compare Medicare Advantage & Supplemental Plans

Medicare Advantage insurance is offered by private insurance companies with a Medicare contract, and replaces Original Medicare Part A and Part B. You must continue to pay your Part B premiums. Medicare Advantage plans typically offer additional benefit options and have less cost-sharing than Original Medicare, and you may have to pay a monthly premium in return for the extra benefits. Medicare Advantage plans come in a variety of formats, such as HMO, PPO and PFFS plans, as well as special needs plans. Medicare beneficiaries can enroll in Medicare Advantage plans if they have Medicare Part A and Part B, but only during designated enrollment periods. These enrollment periods change from time-to-time, so please call us to get the most-up-to-date information.
Source: medicaresolutions.com

Reductions in Medicare Advantage Payments: Impact on Seniors

Posted by:  :  Category: Medicare

[35]This is slightly different conceptually from the elasticities explained in elementary economics textbooks. Those elasticities are typically the “price elasticity of supply” and the “price elasticity of demand,” which measure the effect of a change in price on either supply or demand in isolation from the other. The price elasticity of demand is the ratio of the percent change in the quantity demanded to the percentage change in the price, assuming the supply function stays the same. Likewise, the elasticity of supply assumes the demand function remains unchanged. However, this study follows the example of the CMS actuary and calculates a “benchmark elasticity of enrollment,” a combined elasticity that is the ratio of the percent change in the MA benchmark to the percent change in MA enrollment. This elasticity captures both the supply effect and the demand effect. The supply effect results from lower revenue to MA plan providers, and the demand effect results from MA plans having to provide less generous benefits.
Source: heritage.org

America’s Health Insurance Plans

The Coalition for Medicare Choices is a rapidly growing organization of Medicare Advantage beneficiaries. More than 1.4 million Americans in 50 states have joined the Coalition to protect the benefits they receive through their Medicare Advantage plan. Together, we are working to show Congress that Medicare Advantage plans provide critical benefits and lower out-of-pocket costs to millions of beneficiaries. As Congress debates potential changes to Medicare Advantage, we will make certain that your voices are heard. The Coalition for Medicare Choices is administered by America’s Health Insurance Plans, the national association representing nearly 1,300 member companies providing health insurance coverage to more than 200 million Americans.
Source: ahip.org

Replace Medicare Advantage Cuts with Market

Use market-based bids for benchmark payments. Congress should delink benchmark payments from FFS and instead base payment solely on the bids that MA plans submit to the CMS to provide the traditional Medicare benefit (Parts A and B) to MA beneficiaries. There are a variety of ways to do this. For example, the new MA benchmark payment could be based on the weighted average bid of all plans in each county.[46] Under this method, each bid would be weighted by the proportion of beneficiaries enrolled in that plan in the preceding year. The benchmark payment could also be set at the levels proposed under various premium support proposals, such as the second-lowest cost plan[47] or the average of the three lowest-cost plan bids.[48] Bids would reflect the cost of providing benefits for a beneficiary in average health, and insurers would receive larger or smaller risk-adjusted payments from the government if an enrollee’s health was worse or better than average. If a plan were to bid higher than the benchmark payment, enrollees would pay the difference through increased premiums. If a plan were to bid below the benchmark payment, enrollees would receive the difference in a plan rebate.
Source: heritage.org

Fact Check: Obamacare’s Medicare Cuts

The 100 Most Influential PeopleThe 25 Best Inventions of 2015Ask the ExpertFuture of DrivingFuture of GivingKnow Right NowNew AdventurersNext Generation LeadersPerson of the Year 2015Shaping Our FutureTop 10 Everything of 2015Top of the WorldA Year In Space
Source: time.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

Medicare Advantage Cuts in the Affordable Care Act: April 2014 Update

The overwhelming majority of Medicare Advantage enrollees will face significant benefit cuts in 2015, relative to benefit levels in 2014. This is primarily the result of ACA-mandated changes to the benchmark payment formula, and the elimination of the star rating bonus pilot program. The cuts are somewhat mitigated by changes in risk adjustment and other factors. Compared to the pre-ACA baseline, all beneficiaries are experiencing a substantial benefit reduction. The overwhelming majority of this reduction is due to ACA-mandated changes to the benchmark formulas in effect in 2010 and prior years. The effect of the star rating pilot program is absent, since star ratings were not used to determine payments at all prior to 2012. The effect of year-to-year (and even cumulative) adjustment factors is small compared to the cumulative effects of the benchmark changes mandated by the ACA.
Source: americanactionforum.org

Medicare Sustainable Growth Rate

Section 101 of the Tax Relief and Health Care Act of 2006 (MIEA-TRHCA) provided a 1-year update of 0% for the conversion factor for CY 2007 and specified that the conversion factor for CY 2008 must be computed as if the 1-year update had never applied. Section 101 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA) provided a 6-month increase of 0.5% in the CY 2008 conversion factor, from January 1, 2008, through June 30, 2008, and specified that the conversion factor for the remaining portion of 2008 and the conversion factors for CY 2009 and subsequent years must be computed as if the 6-month increase had never applied. Section 131 of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) extended the increase in the CY 2008 conversion factor that was applicable for the first half of the year to the entire year, provided for a 1.1% increase to the CY 2009 conversion factor, and specified that the conversion factors for CY 2010 and subsequent years must be computed as if the increases had never applied.
Source: wikipedia.org