Summary of Key Changes to Medicare in 2010 Health Reform Law   

Posted by:  :  Category: Medicare

This brief provides a detailed look at the improvements in Medicare benefits, changes to payments for providers and Medicare Advantage plans, various demonstration projects and other Medicare provisions in the law. It includes a timeline of key dates for implementing the Medicare-related provisions in the law.
Source: kff.org

2010 Medicare Part D Program Compared to 2009, 2008 and 2007

Reference-Based Pricing – Under these programs, sponsors may require enrollees to pay a defined cost-sharing amount plus supplemental cost-sharing based on the differential in cost between the drug being dispensed and a lower-cost preferred alternative such as a generic equivalent. In contract year 2009, fewer than 10% of Part D contracts used reference-based pricing. Given the complexity of reference-based pricing formulas, it is very difficult to accurately convey the extent of expected out-of-pocket spending for formulary drugs subject to reference-based pricing. For this reason, CMS has been unable to have the Medicare Prescription Drug Plan Finder (MPDPF) calculate correct pricing for drugs subject to reference-based pricing, which may distort projections of out-of-pocket expenditures for some beneficiaries and significantly affect their ability to compare cost-sharing obligations under different plans and choose the plan that best meets their needs. Based on CMS’ experience and the increased complexity, CMS has observed with these programs, CMS will eliminate the option of reference-based pricing in the Part D Prescription Benefit Program (PBP) beginning in CY 2010. The basis for this decision is CMS’ belief that reference-based pricing may be inherently misleading to beneficiaries and inconsistent with their goal of improving transparency with regard to expected beneficiary cost-sharing under the Part D program.
Source: q1medicare.com

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

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Source: medicare.gov

What’s Medicare Supplement Insurance (Medigap)?

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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

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

Supplements & other insurance

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Source: medicare.gov

Medicare Supplemental Insurance Plans

With a variety of standardized Medicare supplement insurance plans available, it’s important to know your options. Learn about the benefits and how a Medicare supplement insurance plan could be the right fit for you
Source: aarpmedicaresupplement.com

Get Medicare Supplemental Insurance Plan Quotes

As long as you enroll during this six-month Medigap Open Enrollment Period, the insurance company cannot refuse to sell you a Medigap policy, charge you more because you have health problems, or make you wait for coverage to begin. However, you may have to wait up to six months for coverage of a pre-existing condition. Original Medicare will still cover that health problem even if your Medicare Supplement plan doesn’t cover your out-of-pocket costs.
Source: ehealthmedicare.com

Medicare Card: Applying for a New Medicare Card and Replacing a Lost Medicare Card

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Once you have enrolled in the Medicare program, your red, white, and blue Medicare card should arrive in the mail about three months before your coverage begins. For U.S. citizens and legal permanent residents approaching their 65th birthday, enrollment in Medicare could be automatic. This happens if you receive Social Security Administration (SSA) benefits or Railroad Retirement Board (RRB) benefits. In these cases, you are enrolled in Medicare Part A beginning on the first day of the month in which you turn 65, and your card should arrive three months prior to this.
Source: planprescriber.com

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

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Source: medicare.gov

How to Replace a Lost Medicare Card

While you might not really need to replace a lost Social Security card, as a Medicare beneficiary, your red, white, and blue Medicare card is one of the most important pieces of identification you own. Your Medicare card is proof that you are enrolled in Original Medicare and is often needed in order to receive medical services or medications covered by Medicare.
Source: about.com

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

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Source: medicare.gov

Texas Medicare Eligibility and Enrollment Requirements

Texas Medicare eligibility and enrollment requirements state that you or your spouse needed to work at least 10 years in order for the Part A hospital insurance to be free and if not, well you should be able to buy into the program. Contact the Social Security Department to get the current rate. It’s not a bad price but rather expensive for folks on a fixed income. The Part B, out patient part or medical insurance as the government calls it does have a monthly premium that changes almost every year however for 2013 the premium is $104.90 a month for new enrollees. Oh, that could also be more if your loaded financially.
Source: medicareinsurancetexas.com

Texas Medicaid Program: Medicaid State Plan

The electronic version of the Texas Medicaid State Plan Attachments (SPA) pages contain new templates from CMS. These new pages superseded (i.e., replaced) full and partial pages that remain part of the State Plan Attachments. To indicate when a plan page contains superseded information, a red translucent overlay has been added. The top left corner of each overlay contains information about the new pages that supersede that section. Moussing over or clicking the comment box will open a dialog box that indicates which new pages supersede the pages or sections contained inside the red translucent box.
Source: tx.us

Texas Medicare Supplement Plans for 2016

* Network restrictions apply. ** Policy forms UWMSP(A)-2010, UWMSP(F)-2010, UWMSP(F-HD)-2010, UWMSP(G)-2010, UWMSP(K)-2010, UWMSP(L)-2010, UWMSP(N)-2010, UWMSP-SEL(F)-2010, UWMSP-SEL(G)-2010, UWMSP-SEL(K)-2010, UWMSP-SEL(L)-2010, UWMSP-SEL(N)-2010.
Source: texasmedicarehealth.com

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

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Source: medicare.gov

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

NW Medicare Services About

“I am deaf. I received some phone calls from my Medicare plan, and I can’t answer a phone. I asked  NW Medicare Services to please call them and find out what my insurance company wanted. No only did they help me find out the answer, they have been so helpful to me in many ways!!! I so appreciate everything they do for me. Any time I have a question, I can email them and they get right back to me.  NW Medicare Services are a keeper!!!”                                                                                                              Pat – Portland
Source: nwmedicareservices.com

Medicare Eligibility and Enrollment

Posted by:  :  Category: Medicare

re already getting Social Security checks, you will be automatically enrolled in traditional Medicare. You’ll get your Medicare card three months before your 65th birthday. The benefits kick in on the first day of the month of your 65th birthday. Traditional Medicare, which is also called original Medicare, includes Medicare Parts A and B. Part A is hospital coverage. Part B covers doctor visits, lab tests, and other outpatient services.
Source: webmd.com

Who can join a Medicare Advantage Plan?

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Source: medicare.gov

Medicare Eligibility Requirements

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

Qualifications for Medicare

Medicare will cover a limited amount of home health care services as an alternative to entering a nursing home when certain criteria are met. A home health agency must be Medicare certified, and a doctor must make the decision whether or not home care is needed. Medicare does not cover custodial care (non-nursing personal care) unless it is needed in combination with skilled nursing care for the recovery or rehabilitation of a short-term illness.
Source: careathomefl.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

Extra Help with Medicare Prescription Drug Plan Costs

Medicare beneficiaries can qualify for Extra Help with their Medicare prescription drug plan costs. The Extra Help is estimated to be worth about $4,000 per year. To qualify for the Extra Help, a person must be receiving Medicare, have limited resources and income, and reside in one of the 50 States or the District of Columbia.
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

J8 MAC Part B Provider Home Page

Applicable FARSDFARS Restrictions Apply to Government Use. This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60654. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (November 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements.
Source: wpsmedicare.com

J5 MAC Part B Provider Home Page

Applicable FARSDFARS Restrictions Apply to Government Use. This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60654. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (November 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements.
Source: wpsmedicare.com

2014 ASP Drug Pricing Files

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Source: cms.gov

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

Posted by:  :  Category: Medicare

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Source: medicare.gov

Medicare Explained: Understanding the Basics from Part A to Part D

Health care is one of the toughest financial challenges you’ll face in retirement. For millions of retirees, Medicare coverage that takes effect for most people at age 65 is the key to being able to afford health care costs that would otherwise quickly sap their retirement savings. But over the years, Medicare has gotten increasingly complicated, and with the emergence of Obamacare, Americans are struggling to understand exactly how to get their health care covered. To help you get a handle on Medicare, let’s run through the different types of coverage the program provides. The Medicare Alphabet Since 1965, Medicare’s two original components have helped cover basic health needs. The first, known as Part A, focuses on the costs of health care at medical facilities, providing coverage for medically necessary care at hospitals while you’re receiving inpatient care. Under some circumstances, it also covers costs for home health services, hospice care, and skilled nursing facilities. However, nursing home costs are covered only for limited purposes and time periods. Medicare Part B covers the costs of health care outside medical facilities, such as doctors’ visits, outpatient procedures, and lab tests. It also helps cover the cost of services related to health care, such as wheelchairs and scooters, oxygen tanks, and ambulance services. In addition to providing coverage for health care needs that qualify as medically necessary, Part B also covers certain preventive-care services, such as screening for heart conditions, diabetes, and certain types of cancer. In addition to government-provided Parts A and B, Medicare Part C is optional private insurance that Humana (HUM), Aetna (AET), UnitedHealth (UNH), and others provide. Better known as Medicare Advantage Plans, Part C involves paying premiums to those insurers, which then provide coverage for charges that Parts A and B don’t pay for. Medicare Advantage Plans vary greatly both in cost and in scope of coverage, so you have to look closely at all your options to make sure they fit what you want from a plan. Finally, Medicare Part D provides prescription drug coverage. Like Medicare Advantage Plans, Part D plans are offered through private insurance companies, and the coverage that different policies offer can vary widely from insurer to insurer and from plan to plan. In fact, many Part C Medicare Advantage Plans include Part D options within a single package. How You Pay for Medicare Each part of Medicare has different charges associated with it. For Part A, those who’ve had Medicare taxes withheld from their pay for at least 40 calendar quarters during their lifetime are eligible for free coverage.
Source: dailyfinance.com

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

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

Frequently Asked Questions

Posted by:  :  Category: Medicare

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Source: medicare.gov

Frequently Asked Questions (FAQs)

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Source: cms.gov

Local Coverage Determinations (LCDs) for CGS Administrators, LLC (18003, DME MAC)

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NOTE: You either have javascript disabled or have saved the page locally. Your experience may not be optimal due to these factors. Please consider enabling javascript or revisiting this page to get an optimal MCD experience. (Due to browser security settings, directly clicking the previous link may not work, so you may need to copy and paste the following link [http://www.cms.gov/medicare-coverage-database/indexes/lcd-list.aspx?Cntrctr=140&name=CIGNA+Government+Services+(18003,+DME+MAC)&ContrNum=18003&CntrctrType=DME] into your browser.)
Source: cms.gov

Cigna Medicare Supplement Plans

Cigna Medicare supplement plans are another big name option for Medicare supplement insurance.  They are one of the larger health insurance companies in the United States. However, they also offer coverage globally to corporations that employ workers overseas, and they have an international branch that services 30 additional countries.  Cigna was originally founded in 1982 and their headquarters are located in Bloomfield, Connecticut. Their signature slogan is “Cigna: more than just a health insurance company.” They are dedicated to helping improve the health, well-being, and sense of security of their clients and customers. Cigna Medicare supplement insurance is only one of the health insurance options they offer, but they do offer all of the Medicare supplement plans available. To apply for Cigna Medicare supplement insurance you must but 65 years old and currently or pending enrollment in basic Medicare Part A and B.
Source: gomedigap.com