New Medicare Benefits and Changes for 2011

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Once your total drug costs reach $4,550 (see the Ms. Medicare column "Paying Less for Drugs in the Doughnut Hole" for details about how this is calculated), you are eligible for "catastrophic coverage" and your prescription costs drop to a lower copay for the remainder of the year. Last year, when there were no doughnut-hole discounts, $250 rebate checks were sent to all affected Part D subscribers. Because of the discounts now in place, there will be no rebate checks for 2011 expenses. Another 2011 change for Part D subscribers is that if you have a high annual income (more than $85,000 for individuals and $170,000 for couples) and pay higher-income premiums for Part B, you’ll also pay a higher premium for Part D drug coverage.
Source: aarp.org

Significant 2011 Changes for Medicare Advantage

In 2011, Medicare Advantage beneficiaries may experience any or all of these changes, but there are some major program-wide changes to consider. Taking the time to learn and understand the changes will give you the information you need to make a sound decision about your 2011 Medicare Advantage policy. These changes do not apply to Medicare supplement policies.
Source: emedicaresupplements.com

Learn What to do If you Already Have Medicare Health Coverage

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Yes. Coverage from an employer through the SHOP Marketplace is treated the same as coverage from any job-based health plan. If you’re getting health coverage from an employer through the SHOP Marketplace based on your or your spouse’s current job, Medicare Secondary Payer rules apply.
Source: healthcare.gov

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

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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 Information, Help, and Plan Enrollment

Humana is a Medicare Advantage HMO, PPO and PFFS organization and a stand-alone prescription drug plan 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. Plan Formulary may change at any time. You will receive notice when necessary. Benefits, premiums, and/or co-payments and/ or co-insurance may change on January 1 of each year.
Source: medicare.com

Medicare Summary Notice (MSN)

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MSNs are usually mailed four times a year and contain information about submitted charges, the amount that Medicare paid, and the amount you are responsible for. Note that you may receive an MSN more often if you are being reimbursed for a bill you paid. You can also access your MSN online at www.mymedicare.gov. This site allows you to look at electronic versions of your MSNs and print copies from your own computer whenever you would like (but it does not replace the paper MSN).
Source: medicareinteractive.org

How to Read Your Part B Medicare Statement

Medical procedures and services are assigned billing codes. You have the right to receive an itemized billing statement that lists each medical service you received. If you need an itemized statement, contact your doctor. Compare the billing code on your MSN with the code that appears on the billing statement you received from your doctor. If the codes are different, or if you didn’t receive the medical service indicated, contact the doctor who is making the claim. It may be a simple mistake that the doctor’s office can easily correct. If the office does not resolve your concerns, call Medicare at 1-800-MEDICARE (1-800-633-4227).
Source: aarp.org

Redesigned with you in mind – your Medicare Summary Notice

The Medicare Summary Notice has a new look to help you better understand your Medicare information. We’re excited to announce that you will soon start to see the award-winning, redesigned Medicare Summary Notice (MSN) hitting your mailboxes.  The new design puts clear language in an easy-to-follow format, so that your Medicare information is easier to understand.
Source: medicare.gov

Medicare Part D Plans and Guide, Prescription Drug Plans

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En español l Medicare has an optional program — called Medicare Part D — that provides insurance to help you pay for prescription drugs. If you select to have the coverage, you pay a monthly premium. This guide explains how the program works and helps you make decisions in choosing a plan that’s right for you.
Source: aarp.org

Prescription Drug Coverage

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Source: cms.gov

Medicare Part D Prescription Drug Plans Coverage and Comparison

Medicare Part D Prescription Drug Plans, also known as “PDPs,” are stand-alone prescription drug plans that are sold by private insurance companies with a Medicare contract. Medicare beneficiaries can sign up for a PDP if they would like to add Part D drug coverage to their Original Medicare coverage. Certain Medicare Advantage plans, such as Cost Plans, Private Fee-for-Service (PFFS) plans, and Medical Saving Account (MSA) plans might allow you to add a stand-alone PDP to this coverage, although these situations may vary. Anyone enrolled in Medicare Part A and/or Medicare Part B is eligible to enroll in a Medicare Part D plan.
Source: planprescriber.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

Get Medicare Part D Plan Quotes

Medicare Part D prescription drug coverage, often referred to as Part D, is provided and coordinated by Medicare-approved private insurance companies. Any beneficiary who is eligible for Original Medicare, Part A and/or Part B, and permanently resides in the service area of a Medicare Prescription Drug Plan, can sign-up for Medicare Part D. Medicare Part D coverage is optional, but if you don’t enroll in Part D as soon as you’re eligible, you might pay a late-enrollment penalty if you enroll later.
Source: ehealthmedicare.com

Remittance Advice Remark Codes

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The law permits exceptions to the refund requirement in two cases: – If you did not know, and could not have reasonably been expected to know, that we would not pay for this service; or – If you notified the patient in writing before providing the service that you believed that we were likely to deny the service, and the patient signed a statement agreeing to pay for the service. If you come within either exception, or if you believe the carrier was wrong in its determination that we do not pay for this service, you should request appeal of this determination within 30 days of the date of this notice. Your request for review should include any additional information necessary to support your position. If you request an appeal within 30 days of receiving this notice, you may delay refunding the amount to the patient until you receive the results of the review. If the review decision is favorable to you, you do not need to make any refund. If, however, the review is unfavorable, the law specifies that you must make the refund within 15 days of receiving the unfavorable review decision. The law also permits you to request an appeal at any time within 120 days of the date you receive this notice. However, an appeal request that is received more than 30 days after the date of this notice, does not permit you to delay making the refund. Regardless of when a review is requested, the patient will be notified that you have requested one, and will receive a copy of the determination. The patient has received a separate notice of this denial decision. The notice advises that he/she may be entitled to a refund of any amounts paid, if you should have known that we would not pay and did not tell him/her. It also instructs the patient to contact our office if he/she does not hear anything about a refund within 30 days
Source: wpc-edi.com

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

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Source: medicare.gov

Centers for Medicare & Medicaid Services

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Source: cms.gov

International Health Insurance & Medical Insurance

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Bupa Global is a trade name of Bupa, an independent licensee of Blue Cross and Blue Shield Association, an association of independent BlueCross and BlueShield Plans. Restrictions and limitations apply in some areas. For more information, visit bupaglobalaccess.com. The Blue Cross Blue Shield Association is an association of 36 independent, locally operated Blue Cross and Blue Shield companies. Blue Cross Blue Shield Global is a brand owned by the Blue Cross and Blue Shield Association
Source: bupaglobal.com

Cost of Medicare Part B & Part A

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There is a monthly premium for Part B coverage. How much you pay in 2016 is based on how you paid it in 2015 because there was no cost-of-living increase for 2016 Social Security benefits. If you had your premium withheld from your Social Security check in 2015, then you continue to pay $104.90 in 2016. If you didn’t have your premium withheld in 2015 or are new to Medicare in 2016, then your monthly premium is $121.80. It could also be higher than $121.80 depending on how much money you earn. If you’re single with an income of $85,000 or more OR married with an income of $170,000 or more, you will pay a higher premium. Medicare beneficiaries who meet certain income and resource guidelines can get their Part B premium paid for by their state’s Medicare Savings Program.
Source: mymedicarematters.org

Medicare Part B: Doctor Costs and Lab Tests

Preventive services. Medicare Part B helps pay for a number of tests, screenings, vaccinations, and a one-time physical exam to help you stay healthy. Many of these services are available at no cost at the time of the visit. Part B also covers screening and counseling for alcohol use (for people who are not considered alcoholic), obesity screening and counseling, screening for depression, sexually transmitted infections screening and counseling, and cardiovascular behavioral counseling.
Source: webmd.com

Medicare Information, Help, and Plan Enrollment

Humana is a Medicare Advantage HMO, PPO and PFFS organization and a stand-alone prescription drug plan 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. Plan Formulary may change at any time. You will receive notice when necessary. Benefits, premiums, and/or co-payments and/ or co-insurance may change on January 1 of each year.
Source: medicare.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

When & how to sign up for Part A & Part B

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Source: medicare.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

Rules for Medicare health plans

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Source: medicare.gov

Meaningful Use Regulations

The Medicare and Medicaid EHR Incentive Programs include three stages with increasing requirements for participation. All providers begin participating by meeting the Stage 1 requirements for a 90-day period in their first year of meaningful use and a full year in their second year of meaningful use. After meeting the Stage 1 requirements, providers will then have to meet Stage 2 requirements for two full years. CMS has recently published a proposed rule for Stage 3 of meaningful use which focuses on the advanced use of EHR technology to promote health information exchange and improved outcomes for patients.
Source: healthit.gov