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

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Source: medicare.gov

Welcome To The Oklahoma Health Care Authority

Due to inclement weather, the Governor has authorized state agencies to reduce non-essential services as of 3:00PM CST on Tuesday, April 26th. As a result, OHCA will be closing at that time. Thank you for your patience and be safe.
Source: okhca.org

Oklahoma Insurance Department

The Senior Health Insurance Counseling Program (SHIP) is a non-profit organization helping to inform the public about Medicare and other senior health insurance issues. This division provides accurate and objective counseling, assistance, and advocacy relating to Medicare, Medicaid, Medicare supplements, Medicare Advantage, long-term care, and other related health coverage plans for Medicare beneficiaries, their representatives, or persons soon to be eligible for Medicare.
Source: ok.gov

Compare Oklahoma Medicare Insurance Plans

Oklahoma offers a two-year, nonrefundable credit for small employers that that (a) have done business in the state for at least one year; (b) have not, within the 15 preceding months of offering to purchase the state-certified plan, provided group health insurance to at least 75% of its employees who are residents of the state and work an average of 24 hours or more a week for the employer; (c) offer the state-certified basic health benefits plan to all eligible employees; and (d) pay 50% or more of the full cost of the premium attributable to the employee for which the credit is claimed. An eligible employee is an employee, proprietor, or partner of the employer claiming the credit who (a) is a state resident, (b) works an average of 24 hours a week or more for the employer, and (c) was not covered by a group health insurance policy or plan offered by the same employer within the 15 months preceding the offer to purchase a state-certified basic health benefits plan. Credit amounts to $15/on the per eligible employee.
Source: medicaresolutions.com

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.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 Supplement Plan J for AL, AR, AZ, CO, DC, FL, GA,
KS, KY, LA, MD, MO, MS, NC, OH, OK, SC, TN, TX, VA & WV.

* A benefit period begins on the first day you receive service as an inpatient in a hospital and ends after you have been out of the hospital and have not received skilled care in any other facility for 60 days in a row. ** We do not recommend The High Deductible plan J. Plan J without the high deductible is very recommended. This high deductible plan pays the same or offers the same benefits as Plan J after you have paid a calendar year $2000 deductible. Benefits from the high deductible Plan J will not begin until out-of-pocket expenses are $2000. Out-of-pocket expenses for this deductible are expenses that would ordinarily be paid by the policy. This includes the Medicare deductibles for Part A and Part B, but does not include the plan’s separate foreign travel emergency and prescription drug deductibles.
Source: themedicarechannel.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

Compare South Carolina Medicare Insurance Plans

Posted by:  :  Category: Medicare

All residents of South Carolina who are over the age of 65 or who have qualifying ailments or disabilities are eligible to receive low-cost or free insurance coverage through the government. Specifically, these individuals may obtain such benefits through the Medicare program, a federally sponsored insurance system. Additionally, while the federal government administers Medicare, the government of South Carolina offers assistance, both informational and financial, to certain eligible beneficiaries. If you have questions about Medicare in South Carolina, use the following information as a guide and contact a professional at Medicare Solutions for help.
Source: medicaresolutions.com

Medicare in South Carolina

Medicare Advantage plans and Medicare Prescription Drug Plans are offered through private insurance companies that contract with Medicare to sell Medicare plans (which can include Medicare HMOs or Medicare Part D Prescription Drug Plans). Depending on the terms of the contract between the plan and Medicare, not every plan is available statewide or in all service areas. Each year, the plan must renew their contract with Medicare, so the availability of a plan in a specific service area is subject to change as a result of the annual contract renewal.
Source: ehealthmedicare.com

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

State of Oregon: Medicare starts at 65

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

Utah UT Medicaid Dentist Public Dental Provider Health Clinic

Posted by:  :  Category: Medicare

Finding an approved dentist in your immediate area can be difficult or frustrating. In general terms, smaller cities have few provider resources that can include general dentists or practices and a variety of specialties. Orthodontists are also listed in a directory at Medicaid Orthodontist.com. The specialty of oral surgery may best be found by finding general dentistry practices that are already enrolled providers. If oral surgery is not available with a particular practice, a referral may be possible from that office. Endodontists (root canal specialists) may also be similarly found. Medicaid recipients may discover they will need to travel to another county or city to find approved practices. Dentists who accept medicaid payment programs for childrens dentistry can be found through the use of a family dental practice that provides general dental care patient of all ages or through Pediatric specialists that are listed, in part, in this directory.
Source: medicaiddentistry.com

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

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Source: medicare.gov

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

Medicare Part D Coverage Gap

Coverage gap, also known as the “donut hole”: While in the coverage gap, you’ll pay 45% of the plan’s cost for brand-name drugs and 58% of the plan’s cost for generic drugs in 2016. You’re out of the coverage gap once your yearly out-of-pocket drug costs reach $4,850 in 2016. Once you have spent this amount, you’ve entered the catastrophic coverage phase. The costs paid by you or someone on your behalf (such as a spouse or loved one) for Part D drugs on your plan’s formulary will count toward your out-of-pocket costs. Additionally, manufacturer discounts for brand-name drugs count towards reaching the spending limit that begins catastrophic coverage. If your plan requires you to get your drugs from a participating pharmacy, make sure you do so, or else the costs may not apply. Keep in mind that costs that are paid for you by other insurance you may have, such as prescription drug coverage through an employer, won’t count towards your out-of-pocket spending.
Source: medicare.com

About the Medicare Coverage Gap

The Medicare coverage gap is the phase of your Medicare Part D benefit when there is a gap in prescription drug coverage. During this phase, you will have to pay more for your drugs, until you reach the catastrophic coverage phase. Most Medicare Advantage Prescription Drug plans and Medicare Prescription Drug Plans have a coverage gap, or “donut hole.” The coverage gap is reached when your total drug costs (what you and your plan pay) reach a certain amount. You then pay for your prescriptions out of pocket until entering the plan’s catastrophic coverage phase. This is when your total out-of-pocket costs, including the annual deductible and copayments/coinsurance, reach $4,850 in 2016.
Source: medicare.com

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

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

Medicare Part D Donut Hole – Prescription Drug Coverage Gap

Most Medicare Part D Prescription Drug Plans have a coverage gap, sometimes called the Medicare “donut hole.” This means that after you and your Medicare drug plan have spent a certain amount of money for covered prescription drugs, you then have to pay all costs out-of-pocket for the drugs, up to a certain out-of-pocket limit. The yearly deductible, coinsurance, or copayments, and what you pay while in the coverage gap, all count toward this out-of-pocket limit. The limit doesn’t include the drug plan’s premium.
Source: ehealthmedicare.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 Part D Plans and Guide, Prescription Drug Plans

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

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

2016 Medicare Part D Prescription Drug Plans: Overview by State

Choose your State from the list below for an overview of the Medicare Part D Prescription Drug Plans available in 2016. Please note – Medicare Part D Plans vary in cost and coverage by State – this means that if you move to a new State during the enrollment year, you may pay a different premium and/or possibly may not have access to the same selection of Medicare Part D plans. Select your state below or choose from one of these links to other tools available to review 2016 Medicare Part D Plans:
Source: q1medicare.com

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

Costs for Medicare drug coverage

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Source: medicare.gov

Medicare Advantage Plan Formularies (Drug Lists)

Coverage limitations: To be covered, drugs must be prescribed for a use that is approved by the FDA or documented in at least one of the specific peer-review compendia identified by the Centers for Medicare and Medicaid Services (CMS). You can find out if any additional prescription drug coverage limitations apply to your drugs by looking at the Prior Authorization. Prior authorization requires you or your doctor to get approval from the plan before your drug is covered. View the prior authorization criteria PDF below that applies to your plan to determine if the drug is covered. You will need the free Adobe
Source: uhcmedicaresolutions.com

Medicare Advantage Drug Formulary

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

Prescription Drug Coverage Contracting

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Source: cms.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

2011 Medicare Part D Program Compared to 2010, 2009, 2008 and 2007

Pharmaceutical manufacturers will be required to provide certain beneficiaries access to discount prices for certain brand drugs purchased under Medicare Part D. The manufacturer discount prices will be equal to 50% of the plan’s negotiated price defined (minus any applicable dispensing fees). These discount prices must be applied prior to any prescription drug coverage or financial assistance provided under other health benefit plans or programs and after any supplemental benefits provided under the Part D plan. The discounted prices will be charged at the pharmacy (point-of-sale). The beneficiary will not have to do additional paperwork, etc. to receive the benefit. These manufacturer discount prices will be made available to Part D enrollees who are in the coverage gap or donut hole (they have reached or exceeded the initial coverage limit and have incurred costs below the annual out-of-pocket threshold). Medicare beneficiaries will not be eligible to receive these discount prices if they are enrolled in a qualified retiree prescription drug plan or are eligible for the low-income subsidy. The costs paid by manufacturers towards the negotiated prices of drugs covered under this manufacturer discount program shall be considered incurred costs for eligible beneficiaries and applied towards their out-of-pocket threshold. This means that the total negotiated retail drug price will be applied to the TrOOP and will count toward getting out of the doughnut hole.
Source: q1medicare.com