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

What’s Medicare Supplement Insurance (Medigap)?

Some Medigap policies also offer coverage for services that Original Medicare doesn’t cover, like medical care when you travel outside the U.S. If you have Original Medicare and you buy a Medigap policy, Medicare will pay its share of the Medicare-approved amount for covered health care costs. Then your Medigap policy pays its share.
Source: medicare.gov

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: What Are Medigap Plans?

If you are going to buy a Medigap plan, the open enrollment period is six months from the first day of the month of your 65th birthday — as long as you are also signed up for Medicare Part B — or within six months of signing up for Medicare Part B. During this time, you can buy any Medigap policy at the same price a person in good health pays. If you try to buy a Medigap policy outside this window, there is no guarantee that you’ll be able to get coverage. If you do get covered, your rates might be higher.
Source: webmd.com

Medigap (Medicare Supplement Health Insurance)

A Medigap policy is health insurance sold by private insurance companies to fill the “gaps” in Original Medicare Plan coverage. Medigap policies help pay some of the health care costs that the Original Medicare Plan doesn’t cover. If you are in the Original Medicare Plan and have a Medigap policy, then Medicare and your Medigap policy will each pay its share of covered health care costs. Generally, when you buy a Medigap policy you must have Medicare Part A and Part B. You will have to pay the monthly Medicare Part B premium ($96.40 in 2011 for most beneficiaries). In addition, you will have to pay a premium to the Medigap insurance company. As long as you pay your premium, your Medigap policy is guaranteed renewable. This means it is automatically renewed each year. Your coverage will continue year after year as long as you pay your premium. In some states, insurance companies may refuse to renew a Medigap policy bought before 1992. Insurance companies can only sell you a “standardized” Medigap policy. Medigap policies must follow Federal and state laws. These laws protect you. The front of a Medigap policy must clearly identify it as “Medicare Supplement Insurance.” It’s important to compare Medigap policies, because costs can vary. The standardized Medigap policies that insurance companies offer must provide the same benefits. Generally, the only difference between Medigap policies sold by different insurance companies is the cost. You and your spouse must buy separate Medigap policies.Your Medigap policy won’t cover any health care costs for your spouse. Some Medigap policies also cover other extra benefits that aren’t covered by Medicare. You are guaranteed the right to buy a Medigap policy under certain circumstances. For more information on Medigap policies, you may call 1-800-633-4227 and ask for a free copy of the publication “Choosing a Medigap Policy: A Guide to Health Insurance for People With Medicare.” You may also call your State Health Insurance Assistance Program (SHIP) and your State Insurance Department. Phone numbers for these Departments and Programs in each State can be found in that publication.
Source: cms.gov

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

Get Medicare Part D Quotes in Seconds

As could be expected, prices for Humana policies rocketed for the 2015 calendar year. Mean premiums for Humana Part D jumped from $21.80 to $38.70. Medicare Part D is priced at $41.55 and Part D Medicare comes in at the slightly lower price of $38.80. Humana’s standalone market share coverage has dropped to 18.6% whereas their Medicare Part D policies have increased to a market share of 12.8%.
Source: medicareaide.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

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

To be eligible for Medicare, one must be a permanent resident or an American citizen 65 years or older, or younger with a qualifying disability. If you are not a citizen of the United States, you can contact the Social Security Administration office to learn if you would be eligible.
Source: medicareconsumerguide.com

Medicare Advantage Drug Formulary

Posted by:  :  Category: Medicare

Generally, if you are taking a drug that was covered at the beginning of the year, we will not discontinue or reduce coverage of the drug during the coverage year except when we receive information from the FDA that a drug is no longer safe or effective. Complete information about these changes is included in the formulary documents above. Group Health Medicare Advantage plans cover both brand name drugs and generic drugs. Generic drugs have the same active-ingredient formula as a brand name drug. Generic drugs usually cost less than brand name drugs and are rated by the Food and Drug Administration (FDA) to be as safe and effective as brand name drugs.
Source: ghc.org

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 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

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

Covered and Excluded Drugs in the Medicare Part D Drug Formulary

Medicare Prescription Drug Plans are available from private insurance companies contracted with Medicare to provide and coordinate prescription benefits to beneficiaries. As a Medicare beneficiary, there are two ways for you to get prescription drug coverage (Medicare Part D): through a stand-alone Medicare Prescription Drug Plan, if you have Original Medicare, or through a Medicare Advantage Prescription Drug plan. Because these plans are offered through Medicare-approved private insurance companies, this basically means that each Medicare Prescription Drug Plan will provide different types of prescription drug coverage. It’s the insurance company that ultimately decides which drugs to cover under its prescription drug plan and at what benefit level.
Source: ehealthmedicare.com

Annual Statistical Supplement, 2011

Posted by:  :  Category: Medicare

Beginning January 1, 2006, upon voluntary enrollment in either a stand-alone PDP or an integrated Medicare Advantage plan that offers Part D coverage in its benefit, subsidized prescription drug coverage. Most FDA-approved drugs and biologicals are covered. However, plans may set up formularies for their drug coverage, subject to certain statutory standards. (Drugs currently covered in Parts A and B remain covered there.) Part D coverage can consist of either standard coverage or an alternative design that provides the same actuarial value. (For an additional premium, plans may also offer supplemental coverage exceeding the value of basic coverage.) Standard Part D coverage is defined for 2006 as having a $250 deductible, with 25 percent coinsurance (or other actuarially equivalent amounts) for drug costs above the deductible and below the initial coverage limit of $2,250. The beneficiary is then responsible for all costs until the $3,600 out-of-pocket limit (which is equivalent to total drug costs of $5,100) is reached. For higher costs, there is catastrophic coverage; it requires enrollees to pay the greater of 5 percent coinsurance or a small copay ($2 for generic or preferred multisource brand and $5 for other drugs). After 2006, these benefit parameters are indexed to the growth in per capita Part D spending (see Table 2.C1). In determining out-of-pocket costs, only those amounts actually paid by the enrollee or another individual (and not reimbursed through insurance) are counted; the exception is cost-sharing assistance from Medicare’s low-income subsidies (certain beneficiaries with low incomes and modest assets will be eligible for certain subsidies that eliminate or reduce their Part D premiums, cost-sharing, or both) and from State Pharmacy Assistance Programs. A beneficiary premium, representing 25.5 percent of the cost of basic coverage on average, is required (except for certain low-income beneficiaries, as previously mentioned, who may pay a reduced or no premium). For PDPs and the drug portion of Medicare Advantage plans, the premium will be determined by a bid process; each plan’s premium will be 25.5 percent of the national weighted average plus or minus the difference between the plan’s bid and the average. To help them gain experience with the Medicare population, plans will be protected by a system of risk corridors, which allow Part D to assist with unexpected costs and to share in unexpected savings; after 2007, the risk corridors became less protective. To encourage employer and union plans to continue prescription drug coverage to Medicare retirees, subsidies to these plans are authorized; the plan must meet or exceed the value of standard Part D coverage, and the subsidy pays 28 percent of the allowable costs associated with enrollee prescription drug costs between a specified cost threshold ($250 in 2006, indexed thereafter) and a specified cost limit ($5,000 in 2006, indexed thereafter).
Source: ssa.gov

2014 Medicare Part D Program Compared to 2013, 2012, 2011 and 2010

The 2014 plan year standardized, combined Annual Notice of Change (ANOC) and Evidence of Coverage (EOC) document will be mailed to current members of all Medicare Advantage (MA) plans, Medicare Advantage with Prescription Drug Coverage (MA-PD) plans, Prescription Drug Only (PDP) plans and cost-based plans offering Part D. MA and MA-PD plans must ensure current members receive the combined ANOC/EOC by September 30, 2013. Plans have the option to include Pharmacy/Provider directories in this mailing. All plans offering Part D must mail their Low-Income Subsidy (LIS) riders and abridged or comprehensive formularies with the ANOC/EOC to ensure current member receipt by September 30, 2013. Exception: Dual Eligible Special Needs Plans (SNPs) that are fully integrated with the State must mail an ANOC with the Summary of Benefits (SB) for member receipt by September 30, 2013 and then send the EOC for member receipt by December 31, 2013. Fully Integrated Dual Eligible SNPs that send a combined, standardized ANOC/EOC for member receipt by September 30, 2013 are not required to send an SB to current members. Note: With the exception of the ANOC/EOC, LIS Rider, and abridged or comprehensive formularies, no additional materials may be sent prior to the beginning of when marketing activities may begin on October 1.
Source: q1medicare.com

Medicare Plans for Different Needs

UnitedHealthcare is dedicated to helping people nationwide live healthier lives. Our goal is to simplify the health care experience, help you meet your health and wellness needs and carry on trusted relationships with care providers. We offer a wide range of Medicare Advantage, Medicare prescription drug and Medicare Special Needs Plans that might be a good fit for you.
Source: uhcmedicaresolutions.com

State of Oregon: Medicare starts at 65

Posted by:  :  Category: Medicare

Oregon provides this information to help you understand Medicare before you turn 65. Even if you continue to work or are not receiving Social Security, you need to know about Medicare to avoid penalties in your Medicare coverage.
Source: oregon.gov

Oregon Health, Dental, Medicare Supplement and Medicare Advantage Plans

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

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

Denver/Boulder Federal Retiree Health Benefits

To join a Kaiser Permanente Medicare Health Plan, you must reside in the Kaiser Permanente Senior Advantage service area in which you enroll. Benefits, premium, and/or copayments/coinsurance may change on January 1 of each year and for group members, at other times in accord with your group’s contract with us. The pharmacy network may change at any time. You will receive notice when necessary. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply.
Source: kaiserpermanente.org

Affordable Health Coverage

Rating and national average are based on Controlling High Blood Pressure 2013 ratings from the Healthcare Effectiveness Data and Information Set (HEDIS) for commercial plans published by the National Committee for Quality Assurance. HEDIS is a tool used by more than 90 percent of America’s health plans to measure performance on important dimensions of care and service. HEDIS is a registered trademark of the National Committee of Quality Assurance (NCQA). For more information, visit ncqa.org.
Source: kaiserpermanente.org

Kaiser Permanente Advantage Plus

• If you are already a Senior Advantage member, you may add Advantage Plus during the annual election period October 15 – December 7 for coverage to become effective on January 1, 2015. If you don’t enroll during the annual election period, you have until March 31, 2015 to enroll. Coverage is effective the first day of the month following the date we receive your completed enrollment form.
Source: kaiserpermanente.org

Medicare Eligibility Requirements

Posted by:  :  Category: Medicare

In purchasing a Medigap Supplemental Insurance Policy, getting enrolled by the initial enrollment period is very crucial. If you apply during the IEP, by law, you are guaranteed that all insurers selling Medigap coverage in your state must offer you all the Medigap Supplemental Policy coverage plans that they sell. In addition, this guarantees, by law, that the insurance rate premiums offered to you will be the same as a person considered to be in good health. This applies, regardless of the fact that your current or past health history may not have been good or you have ongoing health issues.
Source: medicare.net

Medicare Eligibility Rules

If you are age 65 and currently receiving Social Security or Railroad Retirement Benefits, you are eligible for Medicare and you will be automatically enrolled in Medicare Part A and Part B. However, because Part B has a premium, you have the option of declining Part B coverage. In addition, Part B does require payment of a monthly premium of $104.90, barring certain exceptions, for individuals enrolling in Part B January 1, 2016 or later. These premiums can change on an annual basis.
Source: planprescriber.com

Medicare Eligibility Requirements

For people with end-stage renal disease (ESRD), you’re eligible for Medicare if your condition requires a kidney transplant or regular dialysis treatment. In order to qualify for Medicare, you also need to be eligible for or already receiving Social Security or Railroad Retirement Board benefits, or you need to have worked long enough under Social Security, the Railroad Retirement Board, or as a government worker. You can also qualify for Medicare if you’re the spouse or dependent of someone who is eligible for Social Security or Railroad Retirement benefits.
Source: medicareconsumerguide.com

Disability Planner: Medicare Coverage If You’re Disabled

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

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

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

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 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

What Is the Medicare Donut Hole?

Medicare introduced Part D in 2006. Under the initial rules, a senior who signed up with a PDP paid all drug costs until she met the plan’s deductible. After that, Medicare kicked in. The PDP paid 75 percent of covered drugs. The donut hole appeared if drug costs rose above an annual dollar limit. Above the limit, a senior paid 100 percent of prescription costs until she hit a second limit on out-of-pocket spending. Medicare then kicked in and typically paid 95 percent of drug costs. The limits rise over time, based on inflation.
Source: ehow.com

Part D Information for Pharmaceutical Manufacturers

The Medicare Coverage Gap Discount Program (Discount Program) makes manufacturer discounts available to eligible Medicare beneficiaries receiving applicable, covered Part D drugs, while in the coverage gap. In order to participate in the Discount Program, manufacturers must sign an agreement with CMS to provide the discount on all of its applicable drugs (i.e. prescription drugs approved or licensed under new drug applications or biologic license applications). Beginning in 2011, only those applicable drugs that are covered under a signed manufacturer agreement with CMS can be covered under Part D.
Source: cms.gov

The Coverage Gap: Uninsured Poor Adults in States that Do Not Expand Medicaid – An Update

State decisions about Medicaid expansion have implications for the potential scope of Medicaid under the ACA. If all states expanded their Medicaid programs, eligibility for Medicaid in non-expansion states would grow from just over half a million to 5.2 million. Though some of these people can currently purchase subsidized coverage through the Marketplace, there are advantages and disadvantages to Medicaid and private coverage in different states. For example, enrollees may face higher out-of-pocket costs and limited networks for Marketplace coverage than they would for Medicaid, whereas access to specialist care may be problematic in some state Medicaid programs. In addition, while people can enroll in Medicaid throughout the year, Marketplace enrollment is only available during a limited open enrollment period. Medicaid is designed to provide a safety net of coverage for low-income people, with benefits and provider networks targeted to this population and coverage available throughout the year as people’s circumstances change. There is no deadline for states to opt to expand Medicaid under the ACA, and debate continues in some states about whether to expand. If more states adopt the expansion, the coverage gap will shrink and more low-income adults will gain access to Medicaid eligibility.
Source: kff.org

CMS: Cigna banned from selling new Medicare Advantage plans

Posted by:  :  Category: Medicare

The CMS has banned Cigna from offering new Medicare Advantage plans after taking issue with the way the insurer handled appeals, grievances and its drug formulary, according to regulatory filings. The news comes as state and federal regulators scrutinize Cigna’s $48 billion sale to Anthem. The deal would create the nation’s largest insurer. The sanctions, which are not expected to affect current enrollees, took effect Thursday, according to a letter the CMS sent to Bloomfield-Conn.-based Cigna. The insurer said in a Securities and Exchange Commission filing that it is working to resolve the issues and is fully cooperating with the CMS. The company is expected to release a statement on the issue on Friday. Cigna held 3% of the MA market last year, according to the Kaiser Family Foundation. That represents about 502,000 enrollees. In a note to investors, healthcare investment bank Leerink Partners said it estimated about 10% to 12% of Cigna’s earnings come from MA plans. The private Medicare program has been a boon for insurers the past several years, offering sizable volumes and steady profit margins. Some companies have said the growth in MA, spurred in part by the aging baby boomer population, will be fundamentally important to earnings growth in 2015 and beyond. A JPMorgan investors’ note Friday said it does not believe the MA sanctions on Cigna will affect the pending acquisition. It also points out that the suspension, which again affects only new enrollment, fortunately came after Cigna had already experienced a bump in membership before the open-enrollment period ended on Dec. 7. The note also states that Aetna lost 10% of its MA membership during a similar ban from April 2010 to June 2011. Cigna’s shares fell about 1% to $138.74 in morning trading. Sterne Agee analyst Brian Wright said in a note to investors Friday that if the sanctions are lifted by the start of 2017, Cigna shareholders might see a drop of 2 cents a share. If the sanctions extend though next year’s open-enrollment period, shareholders could expect an impact of 33 cents a share on earnings, he said.
Source: modernhealthcare.com

Cigna Faces Halt in Medicare Advantage Enrollment

Cigna Corp. said Friday that enrollment into its Medicare Advantage and prescription-drug plans has been halted by the government, posing a challenge to the insurer as it aims to wind up its acquisition by Anthem Inc.
Source: wsj.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

Compare Medicare Supplement (Medigap) Plans and Rates in Your Area

Posted by:  :  Category: Medicare

"Times have changed since my mother had an AARP J plan and I was totally confused by the options available. Stan walked me through the process in a very educational, methodical, friendly way, and I feel secure now that we’re making the correct decision to provide the best possible coverage for my husband." – Pat K.
Source: medigap360.com

Medicare Supplement Rates

To find sample plans and premium rates, click the �Search Medicare Supplement Rates� link below. The pages on this website are printer friendly. Search results may be exported to Microsoft Excel compatible format. If you need assistance with this website, please click the �Contact Us� link.
Source: fldfs.com

Compare Medicare Supplement Rate for Best Medigap Insurance Plan

And what’s better is that since Medicare Supplement Insurance is standardized from one Medicare Supplement insurance company to the next, you can get the exact same or even better coverage for lower Medigap rates. But who has time to shop dozens of Medigap (Medicare Supplement) insurance companies?  Even more, why would you want to deal with the loads of information that they send you (that is more confusing than it is helpful) or with salespeople that want to come to your home and pressure you to buy what their Medigap insurance company is paying them to sell (not what’s necessarily best for you.)  Well the good news is that you no longer have to.  With one simple phone call to Medigap 360 you will talk to a licensed Medicare Supplement Insurance Specialist.  He or she will be able to help you choose the right Medicare Supplement Plan and ensure that you are saving money and paying fair and lower Medigap Insurance rates.
Source: medigap360.com

Medicare Supplement Rates

This material is for information only. This is a solicitation to sell Aetna Medicare Supplement insurance underwritten by Aetna Life Insurance Company (Aetna). A sales representative may call. Benefits and costs may vary depending upon the insurance plan. Insurance plans are subject to exclusions, limitations and eligibility requirements. Neither Aetna Life Insurance Company nor any of its agents or Medicare Supplement insurance plans are connected with or endorsed by the U.S. or state government, Social Security or Federal Medicare program.
Source: aetnamedicare.com

Medicare Supplement Plans in 2016

Plan G is quickly gaining in popularity due to its great coverage and lower premiums than Plan F. In fact Plan G is almost identical to Plan F in coverage except you must pay the annual Part B deductible ($147 in 2015) yourself with Plan G. After you pay this the plan pays 100 percent just like Plan F does. Many people already on Plan G will remain there as they consider it to be one of the best Medicare supplement plans for 2016.
Source: bestmedicaresupplementplans2016.com

Dental Insurance, Individual Vision Plan, Senior, Medicare Supplement

MWG Insurance Mall is the premier health insurance site online. Here, you’ll find great support in your search for Medicare supplemental insurance, dental insurance, and many other types of coverage. We strive to make our site as accessible as possible. Find a solution for your health insurance needs by relying on us to find the perfect senior life insurance plan, vision plan, or dental coverage. If you require further guidance, reach out to us.
Source: mwginsurancemall.com