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

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Source: medicare.gov

History of Medicare Therapy Caps

February 7, 2003: The Centers for Medicare and Medicaid Services (CMS) issued a program memorandum officially delaying implementation of the therapy cap until July 1, 2003. The memorandum instructs carriers and fiscal intermediaries to implement the $1,500 payment limit on Medicare outpatient therapy services provided on or after July 1 in a prospective manner through December 31, 2003. The cap for 2003 will actually be $1,590 – of which Medicare will pay up to $1,272 – because of the statutory requirement that the cap be indexed to medical inflation. The memorandum confirms that the cap is an annual limitation on allowed incurred expenses per beneficiary. Providers are told to notify beneficiaries about the cap, which was originally established in 1997 but has been under a moratorium, and the settings in which it applies, but not to use advance beneficiary notices (ABNs). Rather, the memo tells providers to use the Notice of Exclusion from Medicare Benefits (NEMB) form to make beneficiaries aware of the cap. Contractors are told to inform beneficiaries when they reach the cap, using existing Medicare Summary Notice messages, which have been revised to advise beneficiaries that the cap exists.
Source: apta.org

What is Medicare? What is Medicaid?

Posted by:  :  Category: Medicare

Medicare Part A, or Hospital Insurance (HI), helps pay for hospital stays, which includes meals, supplies, testing, and a semi-private room. This part also pays for home health care such as physical, occupational, and speech therapy that is provided on a part-time basis and deemed medically necessary. Care in a skilled nursing facility as well as certain medical equipment for the aged and disabled such as walkers and wheelchairs are also covered by Part A. Part A is generally available without having to pay a monthly premium since payroll taxes are used to cover these costs.
Source: medicalnewstoday.com

Readmissions Reduction Program

Aggregate payments for excess readmissions = [sum of base operating DRG payments for AMI x (excess readmission ratio for AMI-1)] + [sum of base operating DRG payments for HF x (excess readmission ratio for HF-1)] + [sum of base operating DRG payments for PN x (excess readmission ratio for PN-1)] + [sum of base operating DRG payments for COPD x (excess readmission ratio for COPD-1)] + [sum of base operating payments for THA/TKA x (excess readmission ratio for THA/TKA -1)]
Source: cms.gov

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

[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.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

More Medicare Information

Posted by:  :  Category: Medicare

If you live in Puerto Rico you will not receive Medicare Medical Insurance (Medicare Part B) automatically. You will need to sign up for it during your initial enrollment period or you will pay a penalty. To sign up, please call our toll-free number at 1-800-772-1213 (TTY 1-800-325-0778). You also may contact your local Social Security office. You can find your local Social Security office by using our Office Locator.
Source: ssa.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

Medicare Plans for Different Needs

Learn about UnitedHealthcare Medicare Advantage plans, Medicare prescription drug plans and Medicare Special Needs plans that might be a good fit for you. Or learn about Medicare-related plans, like Medicare Supplement Insurance plans*.  
Source: uhcmedicaresolutions.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

Contact Information and Websites of Organizations for Medicare

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Source: medicare.gov

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

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 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

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 Supplement Plans (Medigap Plans) and other Medicare / Health Insurance Plans

Posted by:  :  Category: Medicare

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

2016 New Jersey 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

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

TOP RATED NJ ORTHOPEDIC DOCTORS

The skilled orthopedic surgeons at Kayal Orthopaedic Center, PC pride themselves in administering outstanding and innovative orthopaedic care. The orthopedic medical practice, with state-of-the-art facilities in New Jersey, has built its stellar reputation on patient referrals and word-of-mouth recommendations, and is a regional leader and pioneer in customized knee replacement, minimally invasive orthopedic surgery, sports medicine & arthroscopy, partial & total joint replacement surgery, platelet rich plasma injection therapy (PRP), hip arthroscopy, foot & ankle reconstruction, and spinal disorders.  In addition, our providers at the Kayal Osteoporosis Center, PC have expertise in the diagnosis and management of conditions such as osteopenia and osteoporosis, and routinely perform bone density testing with our state-of-the-art GE Lunar Prodigy bone density machines.  Finally, at the Kayal Laser Treatment Center, PC, we utilize the cutting-edge MLS Laser in the non-operative, conservative management of a plethora of musculoskeletal orthopaedic disorders.
Source: kayalortho.com

Medicare Supplemental Insurance — Which policy is best?

Posted by:  :  Category: Medicare

Our recommendation: After picking the benefit combination (Plan A through L) that best suits your needs, buy the issue-age or community-rated Medigap policy with the lowest premium. Even though they are a bit more expensive at the start, your premiums won’t go up every year just because you get older. (AARP’s Medigap plans use a combination of issue-age and community-rated methods; their premiums don’t increase as you get older, but their younger retirees do receive a discount.)
Source: todaysseniors.com

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

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

Your Medicare Supplemental Insurance Information

Every Medicare Supplemental insurance policy, in order to be designated a “Medicare supplemental” or “Medigap” insurance plan, plan has to follow federal and state laws designed to make the buying process easier for the consumer. Medigap insurance companies can only sell you a “standardized” Medigap policy identified by letters A, B, C, D, F, High-Deductible F, G, K, L, M and N. Each standardized Medigap policy must offer the same basic benefits, no matter what insurance company sells it. Cost is usually the only difference between Medigap policies sold by different insurance companies. (You should, however, compare insurance companies on other measures such as customer service and reputation.)
Source: medicaresupplemental.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

Shopping For Medicare Supplemental Insurance

Health insurance from an employer, professional organization, government or military retiree plans. If you remain employed after your 65th birthday, you may be able to continue your group health insurance with your employer and may not need a Medicare Supplement insurance policy. Likewise, if you become eligible for Medicare but are covered by your working spouse’s health insurance, you may not need a Medicare Supplement Insurance policy. Retirees with group health plans from their employers may consider switching to individual Medicare Supplement insurance policies. If you are in this situation, it is important to review each option before making a decision.  Group retiree plans may not cost anything, or the cost may be lower than buying an individual Medicare Supplement insurance policy.
Source: vermont.gov

Medicare Supplement Insurance Quotes

Medicare supplemental insurance plans are not only ideal in the sense that they help individuals to cover loose ends that may not be covered under Medicare, but these plans also maintain the rights and protections set forth under and individuals Medicare insurance plan. Additionally, one can maintain the relationship that they have with their current doctors, even if using a Medicare supplemental insurance plan, ensuring that you are comfortable with the medical attention that you are seeking. Supplemental plans work solely to aid individuals in increasing the benefits that they have under their medical insurance, as detailed on various pages through this website. It is important that you become knowledgeable in the current cost and benefits associated with your Medicare insurance plan, as well as the additional benefits that you may eligible for under a supplemental insurance plan.
Source: medicaresupplementalinsurance.co

Medicare Advantage Plans in Michigan

Posted by:  :  Category: Medicare

Medicare Advantage plans are a lot like the health insurance you may have had before becoming eligible for Medicare. You can choose a complete insurance package with the convenience of one ID card for all services.
Source: bcbsm.com

Affordable Michigan Medicare Plans

insuranceQuotes is an independent, privately-owned company that provides thousands of consumers with an effective and free way to shop and compare insurance quotes online. We are not affiliated with healthcare.gov or other state-based exchanges; however, through trusted partnerships with thousands of insurance agents in your local area and at over a hundred of the nation’s elite insurance providers, consumers using our services can receive quotes for insurance plans that may appear on state-based and/or federal exchanges, as well as for private plans that meet federal standards to be a qualified health plan under the Affordable Care Act. We do not sell health plans ourselves, but work with these licensed entities.
Source: michigan-medicare.com

Michigan Medicare Health Insurance Plans

Medicare is a health insurance program run by the government for people age 65 and older, and for people under 65 with certain disabilities. Understanding more about Medicare will make it easier to choose the right plan. Our Medicare 101 section has resources to help you do that.
Source: bcbsm.com

2016 Michigan 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

Michigan Medicare Plans, Supplement Insurance Plans

Part D of Medicare plan Michigan also termed as Medicare Rx assists in payment of cost related to prescription drugs. At present, this program has been made available in some areas by the federal government. The federal Medicare agency works in concurrence with Michigan insurance companies and some prescription drug providers, and the Medicare Part D benefits is made available in all areas of Michigan. As in the case of Medicare Part B benefits, people from Michigan have the opportunity to choose to pay a monthly premium to take advantage of Part D coverage. However, anybody living outside the U.S. or who are in prison does not qualify for Medicare Part D benefits.
Source: medigap4seniors.com

Medicare Advantage HMO & PPO Plans

Posted by:  :  Category: Medicare

This information is available for free in other languages. Please call our customer service number at 1-888-247-1028 (TTY: 711), Monday through Sunday, 8 a.m. to 8 p.m. Esta información está disponible en otros idiomas de manera gratuita. Comuníquese con Servicios al Cliente al 1-800-282-5366 (TTY: 711). Horario de atención: de 8 a.m. a 8 p.m., los siete días de la semana.
Source: aetnamedicare.com

Blue Medicare PPO and Blue Medicare HMO Providers

Blue Cross and Blue Shield of North Carolina is an HMO, PPO, and PDP plan with a Medicare contract. Enrollment in Blue Cross and Blue Shield of North Carolina depends on contract renewal. Blue Cross and Blue Shield of North Carolina does not discriminate based on race, ethnicity, national origin, religion, gender, age, mental or physical disability, health status, claims experience, medical history, genetic information, evidence of insurability or geographic location within the service area. All Blue Cross and Blue Shield of North Carolina items and services are available to all eligible beneficiaries in the service area.
Source: bcbsnc.com

Medicare Advantage PPO Plans (Preferred Provider Organization)

Generally, beneficiaries can receive their health care from any doctor or health care provider while enrolled in a PPO plan. These plans have network doctors and providers, but plan members are still given the flexibility to choose out-of-network doctors. Be aware that out-of-network care will cost more for the beneficiary as the PPO plan will cover less of the expenses. Some Medicare Advantage plans require beneficiaries to choose a primary care doctor to coordinate their health care, but PPO plans do not have this requirement. Additionally, referrals from a primary care doctor are not required for a beneficiary to see a specialist. Like with other aspects of care under a PPO plan, using an in-network plan specialist will usually cost less than using an out-of-network specialist.
Source: planprescriber.com

Medicare HMO and PPO Coverage and Options

For example: George C. lives in Massachusetts and has a Medicare Advantage Plan through Fallon Community Health, one of the highest-rated health plans in the country. He has an HMO plan with drug coverage. His monthly premium cost for the plan is $208.40 (the Medicare Part B premium of $96.40 plus $112 charged by Fallon). Also, his out-of-pocket expenses include a $15 copay for each PCP visit, $20 for each specialist visit, 10% coinsurance for durable medical equipment, and an annual deductible of $310 for prescription medications.
Source: about.com

Medicare Advantage Plans In Florida

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

Comparing Medicare HMO, PPO, & POS Plans

HMO plans cover health care services provided within a network of contracted physicians and hospitals. Except for emergencies, these plans do not cover care received outside the network. If you have a doctor that you want to keep seeing, then it’s important to make sure that doctor is “in-network” for any HMO you’re considering. Most HMOs require you to have or choose a primary care physician (PCP) in the plan network. Your PCP provides general medical care and authorizes referrals to in-network specialists.
Source: medicaremadeclear.com

2016 Florida Blue Medicare Regional PPO & HMO

A Medicare Advantage organization with a Medicare contract and a Medicare-approved Part D sponsor. These contracts are renewed annually, and the availability of coverage beyond the end of the current contract year is not guaranteed. Exclusions, limitations, copayments, coinsurance and deductibles may apply. The benefit information provided herin is a brief summary, not a comprehensive description of benefits. For more information, contact the plan. Medicare beneficiaries may enroll in BlueMedicare Regional PPO through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov.
Source: securehealthoptions.com

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

Medigap (Medicare Supplement) Insurance

Plans are assigned letters A through N, and are not to be confused with the “parts” of Medicare, such as Parts A & B. Each Medigap policy plan must offer the same basic benefits, no matter which insurance company sells it. For example Plan K from insurance company ABC must offer the same benefits as Plan K from insurance company XYZ.
Source: mo.gov

2016 Missouri 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

Medicare Cost Savings Programs

The SLMB program provides payment of Medicare Part B premiums only for individuals who would be eligible for the QMB program except for excess income. Income for this program must be more than 100% of the FPL, but not exceed 120% or 135% of the FPL.
Source: mo.gov