Costs in the coverage gap

Posted by:  :  Category: Medicare

If you think you’ve reached the coverage gap and you don’t get a discount when you pay for your brand-name prescription, review your next “Explanation of Benefits” (EOB). If the discount doesn’t appear on the EOB, contact your drug plan to make sure that your prescription records are correct and up-to-date. Get your plan’s contact information from a Personalized Search (under General Search), or search by plan name. If your drug plan doesn’t agree that you’re owed a discount, you can file an appeal.
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

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

Cigna Medicare Insurance Plans

Posted by:  :  Category: Medicare

The Medicare Supplement Insurance (Medigap) policies offered provide a way for you to supplement your Original Medicare benefits. While Medicare Part A and B pay for certain hospital stay and physician services provided, Medigap can help you cover your costs associated with Part A and B deductibles, coinsurance, and copayment requirements. It offers seven supplemental Medicare plans with basic to comprehensive coverage for everything from deductibles to copayments, excess charge coverage, and skilled nursing facility care coinsurance costs.
Source: medicaresolutions.com

U.S. government suspends enrollment in Cigna Medicare Advantage, drug plans

n”>The U.S. government has suspended new enrollment in Cigna Corp’s Medicare Advantage health insurance and prescription drug plans, saying Cigna had “widespread and systemic failures” that prevented patients from accessing medical services. The government said Cigna did not handle complaints and grievances properly from patients who had been denied coverage for health benefits or drugs, according to a Jan. 21 letter from its regulator, the Centers for Medicare and Medicaid.
Source: reuters.com

Cigna temporarily banned from new Medicare plans

“Cigna has had a longstanding history of non-compliance with CMS requirements,” the agency said. “Cigna has received numerous notices of non-compliance, warning letters, and corrective action plans from CMS over the past several years. A number of these notices were for the same violations discovered during the audit, demonstrating that Cigna has not corrected issues of non-compliance.”
Source: usatoday.com

Supplements & other insurance

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 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 (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

2016 Florida Medicare Supplement Insurance Plans

The key to finding the perfect plan is to have all of the information in front of you so you can compare plans. Keep in mind, there are significant differences between lettered plans and it makes sense to review everything to ensure you’re making the best choice. Some plans provide coverage if you travel outside the United States, others do not. At Secure Health Options, we can help you locate these options with Florida Blue so you can have all the information you need to make the right decision, easily and conveniently.
Source: myfloridamedicareplan.com

Costs of Medigap Policies

If you buy a Medicare SELECT policy: Medicare SELECT is a type of Medigap policy sold by some insurance companies in some states. If you buy a Medicare SELECT policy, you are buying one of the 10 standardized Medigap Plans A through N. Medicare SELECT policies require you to use specific hospitals and, in some cases, specific doctors to get full insurance benefits (except in an emergency). Generally, Medicare SELECT policies cost less than other Medigap policies. If you have a Medicare SELECT policy and you don’t use a Medicare SELECT hospital or doctor for non-emergency services, your costs will be higher. You will have to pay some or all of what Medicare doesn’t pay. Medicare will pay its share of approved charges no matter which hospital or doctor you choose.
Source: medicare.gov

Medicare Supplemental Insurance Plans

Medicare Supplement Insurance Plans, insured by UnitedHealthcare Insurance Company. If you’re considering a Medicare supplement plan, talking to an agent/producer may offer the direct assistance you’re looking for.
Source: aarpmedicaresupplement.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

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

How Medicare works with other insurance

Posted by:  :  Category: Medicare

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

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

What Is The Best Secondary Insurance With Medicare?

To supplement Medicare it’s best to have a Medicare Supplement Plan. These are standardized plans in most states. The highest level of coverage is the Plan F Medicare Supplement. It pays 100% of the co-pays and deductibles for Medicare covered treatments. The others to consider are Plan G which is the same as Plan F except you pay your Medicare Part B deductible which is less than $150 per year currently. You will often save $200 to $300 annually on your premiums choosing a plan G supplement over a Plan F. You can also consider the Medicare Plan N Supplement for an even lower premium but you will take on more doctor co-pays and a few less benefits. There is a high deductible version of Plan F where you have a much lower premium but you pay the first $2,070 in expenses each year but are covered 100% for costs above that. Medicare and your supplement do not cover prescription medicines so most people buy a Medicare Part D plan for those. None of these plans cover dental or eye doctors so some people buy additional coverage for those. All companies sell the exact same standardized Medicare Supplement Plans so it is the easiest type of insurance to shop and compare and lower your cost. A Plan F with one company may be as much as $500 per year cheaper with a different company and the coverage is exactly the same. It’s best to use an insurance broker who sells for many companies rather than sign up directly through one specific company. When there is a rate increase (they ALL have them) your broker can just re-shop the plans for you and help you get back to a lower premium.
Source: insurancelibrary.com

Medicare Supplemental Insurance Plans

Medicare Supplement Insurance Plans, insured by UnitedHealthcare Insurance Company. If you’re considering a Medicare supplement plan, talking to an agent/producer may offer the direct assistance you’re looking for.
Source: aarpmedicaresupplement.com

What’s Medicare Supplement Insurance (Medigap)?

Posted by:  :  Category: Medicare

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

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

Utah Medicare Supplements

Most existing beneficiaries will be "held harmless" and will pay $104.90 in 2016. Beneficiaries not subject to the “hold harmless” provision will pay $121.80, as calculated reflecting the provisions of the Bipartisan Budget Act signed into law by President Obama last week. Medicare Part B beneficiaries not subject to the “hold-harmless” provision are those not collecting Social Security benefits, those who will enroll in Part B for the first time in 2016, dual eligible beneficiaries who have their premiums paid by Medicaid, and beneficiaries who pay an additional income-related premium. These groups account for about 30 percent of the 52 million Americans expected to be enrolled in Medicare Part B in 2016. 
Source: medicare-utah.net

UTAH Medicare Supplement (Medigap) Insurance Comparison

All plans are available to Medicare recipients on a guaranteed issue basis if the individual is age 65 and already on Medicare Plan B and requesting the coverage within 6 months of turning age 65; or, age 65 or older and within the 6 month period after signing up for Medicare Part B. Certain individuals could also be eligible for guaranteed issue of Plans A, B, C, F, K or L when losing other coverage.
Source: utah.gov

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

Posted by:  :  Category: Medicare

The page could not be loaded. The Medicare.gov Home page currently does not fully support browsers with "JavaScript" disabled. Please note that if you choose to continue without enabling "JavaScript" certain functionalities on this website may not be available.
Source: medicare.gov

Medicare.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

Compare Missouri Medicare Insurance Plans

Finally, the state of Missouri is also committed to helping Medicare beneficiaries understand everything necessary about their insurance. As such, Missouri provides additional help through its state health insurance assistance program, CLAIM. This organization provides counselors who can offer free, unbiased information and advocacy for all Medicare beneficiaries.
Source: medicaresolutions.com

Check the status of a claim

Posted by:  :  Category: Medicare

Check your Medicare Summary Notice (MSN). The MSN is a notice that people with Original Medicare get in the mail every 3 months. It shows all your Part A and Part B-covered services or supplies that providers and suppliers billed to Medicare during a 3-month period, what Medicare paid, and the maximum amount you may owe the provider. Learn more about the MSN, and view a sample.
Source: medicare.gov

How Original Medicare works

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

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

Benefits FAQ: How Does Medicare Work?

Under the Medicare benefits payment system, you get outpatient services the same way you would get them with other types of health insurance. You can receive services from any hospital or community mental health center that participates in the Medicare program.
Source: about.com

Medicare Basics: Hospital Insurance (Part A) and Medical Insurance (Part B)

Today Medicare Part A and Part B are called Original Medicare. Medicare Part A is also known as hospital insurance, and its beneficiaries can expect inpatient hospital stays in a semi-private room to be covered (a private room is not covered unless it is deemed medically necessary). In addition, rehabilitation and other skilled nursing services are also covered. Home health care is covered but only if it’s medically necessary, and then only on a part-time, intermittent basis; this includes physical, occupational and speech therapies when conducted by a Medicare-approved health agency. Durable medical equipment (DME) such as walkers and wheelchairs are covered, as are other medical supplies. Finally, Part A covers hospice care for terminally ill patients and includes drugs and support services for treating symptoms and relieving pain.
Source: howstuffworks.com