Medicare & Secondary Insurance

Posted by:  :  Category: Medicare

Secondary insurance is not the same as supplemental insurance. A secondary insurer could be Medicaid, your employer’s health coverage or your spouse’s workplace coverage, for instance. Supplemental insurance, also called Medigap, is specifically tailored to cover copayments, coinsurance, and deductibles that Medicare doesn’t pay, and possibly services Medicare doesn’t reimburse. Medigap is designed not to cover the same expenses as Medicare.
Source: ehow.com

Medicare as a Secondary Insurance Customer

Often policies have a tendency to overlap or duplicate each other. Take young person’s Medicare health care plans for instance:  often these can reduce the amount paid out by a percentage via a ‘reduction in benefits’ clause, particularly if they are protected under their parent or guardian’s plan. Should this be the case, a secondary insurance policy will pay the balance that is not paid by the primary insurance policy.
Source: bestmedicaresupplement.com

Medicare can be primary or secondary to employer insurance

It is very important that you talk to your benefits manager at your job when you become eligible for Medicare, as your employer insurance will work differently with Medicare. Sometimes companies do not realize that you are eligible for Medicare and they may continue to pay primary when they should not be. When the company realizes they may be able to take back money they paid for your medical services while you should have had Medicare and you may be left very large bills.
Source: medicareinteractive.org

Will my secondary insurance pay for my Medicare deductible and/or 20 percent coinsurance?

Beneficiaries enrolled in Original Medicare may choose to enroll in a Medicare Supplement plan to fill in the gaps in coverage and cover some of the costs of care not covered through Original Medicare. Some Medicare Supplement plans cover the out-of-pocket costs associated with Original Medicare, such as deductibles and coinsurance payments. Therefore, some Medicare Supplement plans may pay for your deductible and/or your coinsurance and/or other out-of-pocket costs not covered by Original Medicare. Contact your Medigap plan directly to see if it covers these costs.
Source: ehealthmedicare.com

How Medicare works with other insurance

A conditional payment is a payment Medicare makes for services another payer may be responsible for. Medicare makes this conditional payment so you won’t have to use your own money to pay the bill. The payment is “conditional” because it must be repaid to Medicare if you get a settlement, judgment, award, or other payment later. You’re responsible for making sure Medicare gets repaid from the settlement, judgment, award, or other payment.
Source: medicare.gov

How Does Secondary Health Insurance Work?

A standalone accidental policy is generally a secondary health insurance policy. This type of supplemental insurance pays if the policyholder is involved in an accident. The policy may have limitations based on what coverage the primary policy provides or may pay specific amounts for specific services. For example, suppose a visit to the emergency room costs the policyholder $10,000 in total charges. The primary health insurance plan then agrees to pay $8,000 of the cost. The accidental policy, the secondary insurance in this example, would then be billed for the remainder.
Source: ehow.com

National health insurance

Posted by:  :  Category: Medicare

National schemes have the advantage that the pool or pools tend to be very very large and reflective of the national population. Health care costs, which tend to be high at certain stages in life such as during pregnancy and childbirth and especially in the last few years of life can be paid into the pool over a lifetime and be higher when earnings capacity is greatest to meet costs incurred at times when earnings capacity is low or non existent. This differs from the private insurance schemes that operate in some countries which tend to price insurance year on year according to health risks such as age, family history, previous illnesses, and height/weight ratios. Thus some people tend to have to pay more for their health insurance when they are sick and/or are least able to afford it. These factors are not taken into consideration in NHI schemes. In private schemes in competitive insurance markets, these activities by insurance companies tend to act against the basic principles of insurance which is group solidarity.
Source: wikipedia.org

United States National Health Care Act

The bill proposes an expansion of the Medicare program to the non-elderly to provide universal coverage and allows individuals to select their own physicians. The bill would create a single-payer system, with Medicare replacing the 1,300 private insurance companies currently involved, which would reduce net costs between $100 and $250 billion annually, based on estimates. The savings relates to the approximately one-third of health care expenses that are spent on administrative overhead rather than medical service delivery. Also, rather than covering 80% of medical costs with the remaining 20% to be paid either out-of-pocket by the patient or via a privately underwritten “supplemental” insurance plan, as Medicare is structured now, HR 676 would cover 100% of all expenses. One of the alternative names for HR 676 among activists is “Medicare for All”, but this is not quite fully accurate, given that if “Medicare for All” were all that really comprised HR 676, then the universal coverage would still need to pay the remaining 20%. Under HR 676 no one will need to do this. Activists claim they use “Medicare for All” as a slogan to increase ease of understanding of what single-payer is among the general U.S. populace, who, they contend, might not understand the scheme as well if a “full” explanation were given from the outset.
Source: wikipedia.org

National Health Insurance

NIC was responsible for creating flexible general insurance products, tailoring them to meet customers’ personalised requirements. Although it is commonplace today for insurers to reach out to customers through bancassurance relationships and tie-ups with auto dealers and other major players, NIC was the first to explore this idea of maximising penetration through partnerships of strategic importance.
Source: bankbazaar.com

What is national health insurance? definition and meaning

A system of insurance benefits established by a federal government to cover all or almost all of the citizens of the country. These systems are entirely or partially funded with tax money. The United States is developing a program like this.
Source: businessdictionary.com

Before Obamacare, the National Health Insurance Plan

According to its supporters, Health Care for America will provide comprehensive coverage. Along with all current Medicare benefits, the plan will cover mental health and maternal and child health. Unlike Medicare, Health Care for America will place limits on total annual out-of-pocket costs paid by enrollees. Drug coverage would be provided directly by Health Care for America, rather than by private health plans. Medicare would be modified to allow it to provide the elderly and disabled with the same direct drug coverage. In addition, preventive and well-child checkups would be provided to all beneficiaries at no out-of-pocket cost.
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

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

Medicare Nursing Home Profile

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

The Medicare & Medicaid Center: What’s the Difference Between Medicare and Medicaid?

Insurance companies are constantly trying to improve the level of service they provide to customers even if it means a lot of work on new products and services. In 2012 Medicare is trying to improve service on their website with the “Blue Button” that should help with navigation. Your information and previous records will be much easier to access with this tool. You can logon from anywhere at any time and be able to access your medical history, health care providers and medications. Continue reading
Source: medicare-medicaid.com

Australian Government Department of Human Services

This information was printed Tuesday 24 May 2016 from humanservices.gov.au/ It may not include all of the relevant information on this topic. Please consider any relevant site notices at humanservices.gov.au/siteinformation when using this material.
Source: gov.au

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

Filing a Medicare Claim and Checking the Status

If you have Original Medicare, the amount you pay at the time you receive a health service will depend on whether your doctor is a Medicare-participating provider and accepts assignment. Medicare-participating providers are on contract with Medicare to accept and treat patients for all Medicare-covered services and supplies. A provider that accepts assignment agrees to accept the Medicare-approved amount as full payment for a covered service or supply. In this instance, the provider is required to file Medicare claims for any services you received, and Medicare will pay the provider directly for those services. The provider is not allowed to charge you to submit the claim.
Source: planprescriber.com

Medicare claims processing manual

27. 20.1.2 – Outliers (Rev. 2111, Issued: 12-03-10, Effective: 04-01-11, Implementation: 04-04-11) §1886(d)(5)(A) of the Act provides for Medicare payments to Medicare-participating hospitals in addition to the basic prospective payments for cases incurring extraordinarily high costs. This additional payment known as an “Outlier” is designed to protect the hospital from large financial losses due to unusually expensive cases. To qualify for outlier payments, a case must have costs above a fixed-loss cost threshold amount (a dollar amount by which the costs of a case must exceed payments in order to qualify for outliers), which is published in the annual Inpatient Prospective Payment System final rule. The regulations governing payments for operating costs under the IPPS are located in 42 CFR Part 412. The specific regulations governing payments for outlier cases are located at 42 CFR 412.80 through 412.86. The actual determination of whether a case qualifies for outlier payments is made by the Medicare contractor using Pricer, which takes into account both operating and capital costs and Medicare severity-diagnostic related group (MS-DRG) payments. That is, the combined operating and capital costs of a case must exceed the fixed loss outlier threshold to qualify for an outlier payment. The operating and capital costs are computed separately by multiplying the total covered charges by the operating and capital cost-to-charge ratios. The estimated operating and capital costs are compared with the fixed-loss threshold after dividing that threshold into an operating portion and a capital portion (by first summing the operating and capital ratios and then determining the proportion of that total comprised by the operating and capital ratios and applying these percentages to the fixed-loss threshold). The thresholds are also adjusted by the area wage index (and capital geographic adjustment factor) before being compared to the operating and capital costs of the case. Finally, the outlier payment is based on a marginal cost factor equal to 80 percent of the combined operating and capital costs in excess of the fixed-loss threshold (90 percent for burn MS-DRGs). Any outlier payment due is added to the MS-DRG adjusted base payment rate, plus any DSH, IME and new technology add-on payment. For a more detailed explanation on the calculation of outlier payments, visit our Web site at http://www.cms.hhs.gov/providers/hipps/ippsotlr.asp. The Medicare contractor may choose to review outliers if data analysis deems it a priority. The IPPS outliers are not applicable to non-PPS hospitals. The Pricer program makes all outlier determinations except for the medical review determination. Outlier payments apply only to the Federal portion of a capital PPS payment. 20.1.2.1 – Cost to Charge Ratios (Rev. 2111, Issued: 12-03-10, Effective: 04-01-11, Implementation: 04-04-11) For discharges before August 8, 2003, Medicare contractors used the latest final settled cost report to determine a hospital’s cost-to-charge ratios (CCRs). For those hospitals that met the criteria in part I. A. of PM A-03-058 (July 3, 2003), effective for discharges occurring on or after August 8, 2003 Medicare contractors are to use alternative CCRs
Source: slideshare.net

How Medicare Part A & B Claims Are Processed (Medicare Billing & Claims)

Medicare pays Part A claims (inpatient hospital care, inpatient skilled nursing facility care, skilled home health care and hospice care) directly to the facility or agency that provides the care. You are responsible for deductibles , copayments and non-covered services. Medicare pays Part B claims (doctors’ services, outpatient hospital care, outpatient physical and speech therapy, certain home health care, ambulance services, medical supplies and equipment) either to your provider or you. This is determined by assignment :
Source: cahealthadvocates.org

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 and amendment 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 fall of 2016 to replace the Health Care Independence Program implemented under the current 1115 waiver authority with Arkansas Works, 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

Arkansas Medicaid Program

To apply for Medicaid, go to the Department of Human Services office in the county where you live. If you are not able to go there, you may have a relative or a friend apply for you. You must sign an application form and give certain information about yourself and your family. The county office will determine your eligibility. When you go to the county office to apply for Medicaid, bring the following information about yourself and your family: – Birth certificate or other proof of age – Paycheck stubs – Social Security card – Letters or forms from Social Security, SSI, Veteran’s Administration, or other sources that show the amount of your income – Insurance policies, including other health insurance policies – Bank books or other papers that show the amount of your assets When you apply for Medicaid, DHS workers will explain the ConnectCare program and ask you to select your primary care physician.
Source: benefits.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

AHIP Medicare + Fraud, Waste & Abuse Training: Login to the site

Now there’s one single source for both Medicare and Fraud, Waste and Abuse (FWA) training. Our comprehensive online program gives you the background to make informed decisions on Medicare, including plan options, marketing, enrollment requirements, and FWA guidelines.
Source: ahipmedicaretraining.com

How to Login & access My Medicare Account section from MyMedicare.gov?

For accessing your Medicare information, Medicare Government has developed an official website www.Medicare.gov. You can find at the official website such as, health and drug plans, health information, plan choices, online services, emergency services and many others. You can easily Login or Sign in at the www.Medicare.gov, This article will helpful you to give full introduction about how to login and create My Medicare Account Sign in at the official site.
Source: letmeget.com

Coventry Medicare: Agents & Brokers

Welcome to the Coventry Health Care Broker Portal, designed to help successfully sell our Medicare products. Coventry is committed to working with our broker and agent partners to help your clients learn more about the Medicare products available through Coventry Health Care. Our Medicare Advantage and Part D Prescription Drug products offer flexible benefit designs and a variety of ways to ensure cost savings.
Source: coventryhealthcare.com

Medicare Prescription Drug, Improvement, and Modernization Act

Posted by:  :  Category: Medicare

The bill came to a vote at 3 a.m. on November 22. After 45 minutes, the bill was losing, 219-215, with David Wu (D-OR-1) not voting. Speaker Dennis Hastert and Majority Leader Tom DeLay sought to convince some of dissenting Republicans to switch their votes, as they had in June. Istook, who had always been a wavering vote, consented quickly, producing a 218-216 tally. In a highly unusual move, the House leadership held the vote open for hours as they sought two more votes. Then-Representative Nick Smith (R-MI) claimed he was offered campaign funds for his son, who was running to replace him, in return for a change in his vote from “nay” to “yea.” After controversy ensued, Smith clarified no explicit offer of campaign funds was made, but that he was offered “substantial and aggressive campaign support” which he had assumed included financial support.
Source: wikipedia.org

How to Bill Medicare for Home Health Services: 11 Steps

Medicare was enacted in 1965 to expand the Social Security Act by providing a hospital insurance program with supplemental medical benefits and extended medical assistance for the aged, survivors, and disabled, in addition to improving state public assistance programs. The insurance program is for people who have reached the age of 65 or have particular disabilities and those in the end stages of renal disease. Today, older Americans rely on it to pay for about half of all of their medical costs. One of the important provisions in Medicare coverage is home health care. This provision is intended to allow seniors to remain independent as long as possible. One study indicated that 90% of older Americans want to stay in their home as long as possible.
Source: wikihow.com

Medicare Advantage Patient Bill of Rights Legislation Introduced in Congress 

In an effort to strengthen MA enrollee consumer protections, in June 2014, Congresswoman Rosa DeLauro (D-CT) and Senator Sherrod Brown (D-OH) introduced the Medicare Advantage Participant Bill of Rights Act of 2014 (H.R. 4998/S. 2552).  Senator Richard Blumenthal (D-CT) is a strong advocate and co-sponsor of the bill.  Among other things, this bill would prohibit MA plans from dropping providers during the middle of the plan year unless they can show cause, and would improve notice to plan enrollees about annual changes to provider networks before they commit to joining the plan. The Center for Medicare Advocacy supports this bill.
Source: medicareadvocacy.org

How much of my bill will Medicare Part A pay?

All rules about how much Medicare Part A pays depend on how many days of inpatient care you have during what is called a “benefit period,” or spell of illness. The benefit period begins the day you enter the hospital or skilled nursing facility as an inpatient and continues until you have been out for 60 consecutive days. If you are in and out of the hospital or nursing facility several times but have not stayed out completely for 60 consecutive days, all of your inpatient bills for that time will be figured as part of the same benefit period.
Source: nolo.com

Consumer Guide to Health Care

Posted by:  :  Category: Medicare

Medicare is the main insurance for people 65 and older and also provides coverage for some people with disabilities. It is the nation’s largest health insurance program – covering 49 million Americans in 2012. The federal Centers for Medicare and Medicaid Services (CMS), which runs the program, provides lots of information on its  Medicare website. Here is additional information about the program.
Source: wisconsin.gov

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

"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 Supplemental Insurance — Which policy is best?

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

Medigap insurance plan options

Posted by:  :  Category: Medicare

1. Plan F offers a high-deductible plan. This plan requires you to pay a $2,180 deductible before it covers anything. 2. Plan K has an “Out-of-Pocket” yearly limit of $4,960 (in 2016). After you pay the out-of-pocket yearly limit and yearly Part B deductible, it pays 100% of covered services for the rest of the calendar year. 3. Plan L has an “Out-of-Pocket” yearly limit of $2,480 (in 2016). After you pay the out-of-pocket yearly limit and yearly Part B deductible, it pays 100% of covered services for the rest of the calendar year. 4. Plan N pays 100% of the Part B co-insurance, except for a co-payment of up to $20 for some office visits and up to a $50 co-payment for emergency room visits that don’t result in an inpatient admission.
Source: medicaresupplement.com

Supplements & other insurance

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

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

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

"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

Senior Center Near You in Provo, UT

Posted by:  :  Category: Medicare

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Source: yellowpages.com

Senior Apartments Near You in Provo, UT

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Source: yellowpages.com

Aging & Adult Services

The Utah Department of Human Services prohibits discrimination on the basis of race, color, national origin, age, disability, gender, or religion. DHS is committed to making its programs, benefits, services, and facilities accessible in accordance with Section 504 of the Rehabilitation Act of 1973. If you believe you have been discriminated against for any of these protected categories, please send your written, oral (TTY), or electronic complaint.
Source: utah.gov