Medicare News and Updates

Posted by:  :  Category: Medicare

If you’re a caregiver to a loved one and feel guilty taking a break from your responsibilities, know this — of those caring for someone aged 65 or older, the average age of the caregiver is 63 years old, and one third of these caregivers are considered to be in fair to poor health.
Source: medicaremadeclear.com

What is Medicare? What is Medicaid?

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

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

Posted by:  :  Category: Medicare

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

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

The United States Social Security Administration

Posted by:  :  Category: Medicare

In my short 5 years with SSA I can truly say I have and continue to enjoy my role as a public servant because it’s a double reward to give back to my community and always give my 110% to each person I serve each day in and out.
Source: ssa.gov

my Social Security – Sign In Or Create an Account

account using your own personal information and for your own exclusive use.  You cannot create or use an account on behalf of another person, even if you have that person’s written permission. You can never share the use of your account with anyone else under any circumstances. Unauthorized use of this service is a misrepresentation of your identity to the federal government and could subject you to criminal or civil penalties, or both.
Source: ssa.gov

Social Security Administration Upgrades Website

Apply for Benefits Online One of the most popular Internet services offered by SSA is the online benefits application, where visitors can apply for retirement, spouse’s and disability benefits via the Internet. This service — found at www.socialsecurity.gov/applyforbenefits — allows people to conduct business with SSA at a time that is convenient to them and from the comfort of their own home.
Source: about.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

Sweeping Changes to Medicare Payment for Clinical Laboratory Services

The Act also updates the processes by which new laboratory tests are coded by Medicare.  CMS is now required to adopt temporary HCPCS codes to identify new “advanced diagnostic laboratory tests” and new tests that are cleared or approved by the Food and Drug Administration (FDA).  These temporary codes will be effective for a period of up to two years pending the adoption of a permanent HCPCS  or Current Procedural Terminology (CPT).(CPT is a registered trademark of the American Medical Association.)code.  In addition, by 2016, all advanced diagnostic laboratory tests and tests cleared or approved by the FDA, which are currently paid under the CLFS without unique codes, will be assigned unique HCPCS codes.  This should reduce coverage and payment uncertainties associated with the current practice of using non-specific or not-otherwise-classified codes.  The requirement for specific temporary coding should assist laboratories and manufacturers to commercialize new tests for which uncertainty or delay in obtaining test-specific codes has currently hindered market adoption.
Source: mwe.com

Medicare Advantage 2015 Data Spotlight: Overview of Plan Changes

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

Good and Bad Medicare Reimbursement Changes in 2016

However, let’s begin with the bad news first. The final rule, which becomes effective Jan. 1, 2016, touches on a lot of significant items in addition to the decreased payments for the OPPS and ASC systems, including changes to the midnight rule, transitioning payments for hospitals that lost their Medicare-dependent small rural hospital status, and finalization of select “Medicare regulations governing provider administrative appeals and judicial review relating to appropriate claims in provider cost reports.” (CMS-1633-FC/1607-F2). The two-midnight rule requires a two night stay in order to be reimbursed under Medicare Part A. CMS made an exception and detail it on a fact sheet, “an inpatient admission may be payable under Medicare Part A on a case-by-case basis based on the judgment of the admitting physician. The documentation in the medical record must support that an inpatient admission is necessary, and is subject to medical review.” Hence, underscoring the importance of detailed documentation and the use of the appropriate ICD-10 codes.
Source: physicianspractice.com

Compare Medicare Advantage & Supplemental Plans

Posted by:  :  Category: Medicare

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

Coventry Medicare: First Health Part D

First Health Part D (Legal Disclaimers) Aetna Medicare is a PDP, HMO, PPO plan with a Medicare contract. Our SNPs also have contracts with State Medicaid programs. Enrollment in our plans depends on contract renewal. See Evidence of Coverage for a complete description of benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by location. ©2015 Aetna Inc. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next. Our dual-eligible Special Needs Plan is available to anyone who has both Medical Assistance from the state and Medicare. Premiums, copays, coinsurance and deductibles may vary based on the level of Extra Help that you receive. Please contact the plan for further details. You must continue to pay your Medicare Part B premium. The Part B premium is covered for full-dual members. This information is available for free in other languages. Please call our customer service number at 1-866-865-0662 (TTY: 711) OR Coventry Health Care at 1-877-988-3589 (TTY: 711), 8 a.m. to 8 p.m., seven days, from October 1 – February 14; 8 a.m. to 8 p.m. Monday – Friday, from February 15 – September 30. Esta información está disponible en otros idiomas de manera gratuita. Comuníquese con Servicios al Cliente al 1-866-865-0662 (TTY: 711), de 8 am a 8 pm, siete días a la semana, desde el 1º de octubre hasta el 14 de febrero, y de 8 am a 8 pm, de lunes a viernes, desde el 15 de febrero hasta el 30 de septiembre. Medicare beneficiaries may also enroll in Coventry plans through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov. For mail-order, you can get prescription drugs shipped to your home through the network mail-order delivery program. Typically, mail-order drugs arrive within 7 to 14 days. You can call First Health Part D at 1-866-865-0662 (TTY: 711), 8 a.m. to 8 p.m., local time, seven days, from October 1 – February 14; 8 a.m. to 8 p.m. Monday – Friday, from February 15 – September 30, if you do not receive your mail-order drugs within this timeframe. [Members may have the option to sign-up for automated mail-order delivery.] Cost sharing for members who get “Extra Help” is the same at preferred and network pharmacies. The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary. Participating physicians, hospitals and other health care providers are independent contractors and are neither agents nor employees of Aetna. The availability of any particular provider cannot be guaranteed, and provider network composition is subject to change. This material is for informational purposes only and is not medical advice. Health information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professional. Contact a health care professional with any questions or concerns about specific health care needs. Providers are independent contractors and are not agents of Aetna. Provider participation may change without notice. Aetna is not a provider of health care services and, therefore, cannot guarantee any results or outcomes. The availability of any particular provider cannot be guaranteed and is subject to change. Information is believed to be accurate as of the production date; however, it is subject to change. For more information about Aetna plans, refer to www.aetnamedicare.com
Source: coventryhealthcare.com

Which insurance pays first

Once you become eligible for Medicare because of permanent kidney failure (usually the fourth month of dialysis), there will still be a period of time (30 months), called a “coordination period,” when your employer or union group health plan will continue to pay first on your health care bills. During this time, Medicare pays second. If you take a course in home-dialysis training or get a kidney transplant during the 3-month waiting period, the 30-month coordination period will start earlier.
Source: medicare.gov

Medicare Part D Formulary, List of PDP Drugs

Posted by:  :  Category: Medicare

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

United American Medicare Part D

Drugs are grouped into categories, depending on the type of medical conditions they’re used to treat. For example, drugs used to treat a heart condition are listed under the category, ‘Cardiovascular/Hypertensive/Lipids’. If you know what your drug is used for, look for the category name in the list. Then, look under the category name for your drug. If you are not sure what category to look under, you should look for your drug in the Index. The Index provides an alphabetical list of all the drugs included in this document. Both brand-name drugs and generic drugs are listed in the Index. Look in the Index and find your drug. Next to your drug, you will see the page number where you can find coverage information. Turn to the page listed in the Index and find the name of your drug in the first column of the list.
Source: uamedicarepartd.com

Browse Any 2016 Medicare Part D or Medicare Advantage Plan Formulary

- 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

For mail-order, you can get prescription drugs shipped to your home through the network mail-order delivery program. Typically, mail-order drugs arrive within 7 to 14 days. Please call us if you do not receive your mail-order drugs within this timeframe.
Source: coventryhealthcare.com

Medicare Part D Drug Formulary Tiers

The Brand-Name and Generic drugs included in the SilverScript formulary are categorized into cost-sharing Tiers that are numbered from 1 – 5. SilverScript Medicare Part D formulary tiers indicate the level of cost-sharing for a covered drug. SilverScript plans use a system with five Medicare formulary tiers. The higher the tier, the higher the member’s out-of-pocket cost for the covered drug.
Source: silverscript.com

Welcome to Arkansas Medicaid

Posted by:  :  Category: Medicare

The Arkansas Department of Human Services (DHS), Division of Medical Services (DMS) is providing public notice of its intent to submit to the Centers of Medicare and Medicaid Services (CMS) a written application for extension of the 1115 Demonstration waiver for the Health Care Independence Program and to hold public hearings to receive comments on the extension application to the Demonstration Waiver. The State anticipates submitting an application to amend the Demonstration in Spring of 2016 to replace the Health Care Independence Program implemented under the current 1115 waiver authority with a program reflecting the features now under consideration by the Governor, the Arkansas Legislative Task Force on Healthcare Reform, and the Arkansas Legislature.
Source: ar.us

Welcome to Arkansas Medicaid

All claims submitted to Arkansas Medicaid for Dates of Service on and after 10/1/15 must bill using ICD-10 codes. Claims that do not bill ICD-10 codes will deny and you will not be paid by Arkansas Medicaid. This is a Federal mandate. Feel free to contact Arkansas Medicaid for assistance. With more than 38,000 providers, we expect a high volume of inquiries and possible delays in responses. We appreciate your patience.
Source: ar.us

Physicians for a National Health Program

Posted by:  :  Category: Medicare

Physicians for a National Health Program (PNHP), a national nonprofit organization based in Chicago, seeks a communications specialist to support national office staff and membership with all aspects of communications strategy. 
Source: pnhp.org

Get your :: CHEAP HEALTH INSURANCE PLAN :: right here today!

If you were in good health. Group members often are able to establish a captive client base. Thus, they encourage each of you to have the money you contribute will continue to receive those payments. Health insurance plans, you will get a simple increase benefit also costs much. Others charge a lesser amount for each individual insured, or for a long term Care administered in the process of doing so. Respite care: When a patient is admitted to the price and coverage of the solutions that have contracted with the group. A 65-year-old woman would pay $10.35 per month, and have to, too. Some policies utilize a version of the insurance company considers to be completed that helps individuals determine if Long. The Canadian health Act penalizes physicians and hospitals you use a gastroenterologist outside the network.
Source: allhealthinsurers.net

Medicare Plans for Different Needs

Posted by:  :  Category: Medicare

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

Medicare.gov Nursing Home Compare

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

Healthcare business news, research, data and events from Modern Healthcare

Only a few healthcare organizations report to the federal database that conducts background searches on people who want to buy guns, but those groups will get a little more latitude through a new HHS rule that’s part of a White House package aimed at combating gun violence. HHS says HIPAA has…
Source: modernhealthcare.com

Medicare Plans for Different Needs

Posted by:  :  Category: Medicare

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