Electronic Billing & EDI Transactions

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The information in this section is intended for the use of health care providers, clearinghouses and billing services that submit transactions to or receive transactions from Medicare fee-for-service contractors. EDI is the automated transfer of data in a specific format following specific data content rules between a health care provider and Medicare, or between Medicare and another health care plan. In some cases, that transfer may take place with the assistance of a clearinghouse or billing service that represents a provider of health care or another payer. EDI transactions are transferred via computer either to or from Medicare. Through use of EDI, both Medicare and health care providers can process transactions faster and at a lower cost. Please see pages on specific types of EDI conducted by Medicare for related links and downloads as applicable.
Source: cms.gov

Contact UnitedHealthcare®

If you are a Provider and require assistance, you may contact UnitedHealthcare plans by calling the toll-free General Provider line. Please do not call the Customer Service number listed throughout this website. Providers are routed by their Tax ID.
Source: uhcmedicaresolutions.com

DMEPOS Competitive Bidding

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Under the program, a competition among suppliers who operate in a particular competitive bidding area is conducted. Suppliers are required to submit a bid for selected products. Not all products or items are subject to competitive bidding. Bids are submitted electronically through a web-based application process and required documents are mailed. Bids are evaluated based on the supplier’s eligibility, its financial stability and the bid price. Contracts are awarded to the Medicare suppliers who offer the best price and meet applicable quality and financial standards. Contract suppliers must agree to accept assignment on all claims for bid items and will be paid the bid price amount. The amount is derived from the median of all winning bids for an item.
Source: cms.gov

Competitive Bidding Program areas

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Source: medicare.gov

The competitive bidding demonstration

If you are already renting equipment when the competitive bidding program starts in your area, you can keep using your current supplier if it becomes a contract supplier or if it chooses to become a grandfathered supplier. Grandfathered suppliers are non-contract suppliers who agree to continue renting you equipment until your rental period ends. Like contract suppliers, they cannot charge you more than the 20 percent
Source: medicareinteractive.org

Medicare : Congresswoman Renee Ellmers

Section 302 of the Medicare Modernization Act of 2003 (MMA) established requirements for a new Competitive Bidding Program for certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS). Under the program, DMEPOS suppliers compete to become Medicare contract suppliers by submitting bids to furnish certain items in competitive bidding areas, and the Centers for Medicare & Medicaid Services (CMS) awards contracts to enough suppliers to meet beneficiary demand for the bid items. The new, lower payment amounts resulting from the competition replace the Medicare DMEPOS fee schedule amounts for the bid items in these areas. All contract suppliers must comply with Medicare enrollment rules, be licensed and accredited, and meet financial standards. The program sets more appropriate payment amounts for DMEPOS items while ensuring continued access to quality items and services, which will result in reduced beneficiary out-of-pocket expenses and savings to taxpayers and the Medicare program.
Source: house.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

Rules for Medicare health plans

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Source: medicare.gov

Medicare Eligibility Rules

If you are age 65 and currently receiving Social Security or Railroad Retirement Benefits, you are eligible for Medicare and you will be automatically enrolled in Medicare Part A and Part B. However, because Part B has a premium, you have the option of declining Part B coverage. In addition, Part B does require payment of a monthly premium of $104.90, barring certain exceptions, for individuals enrolling in Part B January 1, 2016 or later. These premiums can change on an annual basis.
Source: planprescriber.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

How Medicare Advantage Plans work

Posted by:  :  Category: Medicare

Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by private companies approved by Medicare. If you join a Medicare Advantage Plan, you still have Medicare. You’ll get your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage from the Medicare Advantage Plan and not Original Medicare.
Source: medicare.gov

Medicare Advantage: Private Health Insurance Through Medicare

Medicare Advantage plans may give you some discounts or pay for services that Original Medicare may not cover. However, Medicare Advantage plans are administered by private health insurers and you’ll be required to follow your plan’s rules. Original Medicare allows you to see just about any doctor and go to any hospital that accepts Medicare , which most providers accept. With Medicare Advantage plans, you’re typically restricted to the doctors and hospitals included in the plan’s network. You might need referrals to see a specialist.
Source: webmd.com

ADVANTAGE Health Solutions

ADVANTAGE Health Solutions will not offer Medicare Advantage Plans in 2016. We have reached a mutual termination agreement with CMS and will exit the market effective January 1, 2016. For more information please click here.
Source: advantageplan.com

Get Medicare Advantage Plan Quotes

Initial Coverage Election Period: You can enroll into a Medicare Advantage plan or Medicare Advantage Prescription Drug plan when you first become eligible for Medicare. Your Initial Coverage Election Period (ICEP), is a seven-month period that starts 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65. If you are under age 65 and you receive Social Security disability, you qualify for Medicare in the 25th month after you begin receiving your Social Security benefits. If you fall into this category, you may enroll into a Medicare Advantage plan 3 months before your month of eligibility, during the month of eligibility, and 3 months after the month of eligibility. For example, if your Medicare Part A and Part B coverage begins in May, your Medicare Advantage plan ICEP is February through August. See Medicare Advantage Plans
Source: ehealthmedicare.com

2016 Medicare Premiums and Deductibles

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You may be able to avoid paying this late enrollment penalty if you delayed Medicare Part B because you had other health coverage, such as through an employer-sponsored group plan (either through your own or your spouse’s work). In this case, you can enroll through a Special Enrollment Period when you or your spouse stop working or that other health coverage ends, whichever comes first. If you have to pay a monthly premium for Medicare Part A, you may decide to delay enrollment in Part A as well and sign up during your Special Enrollment Period. If you enroll in Medicare with a Special Enrollment Period, you generally won’t have to pay a late enrollment penalty.
Source: medicare.com

Medicare Part B Monthly Premium 2016

Actually, these numbers are valid for most persons on Medicare. You will have to pay a higher premium if you filed an individual tax return last year and reported income over $85,000 or $170,000 for a joint return. Depending on the amount of your taxable income, you may have to pay between $170.50 up to the maximum Part B premium of $389.80 per person. Fortunately, income-related adjustments affect less than 5 percent of Medicare beneficiaries. If you have to pay a higher Part B premium because of your income, you should be notified by Social Security.
Source: medicareanswers.org

Will Medicare Premium Increases Be an Issue in November?

The legislative language used, however, allows premium spikes to come back with a vengeance. The Bipartisan Budget Act provided that the Medicare Part B “smoothing” provision would be renewed in 2017—but only if Social Security beneficiaries received no cost-of-living adjustment at all. The trustees report out Wednesday says that beneficiaries are projected to receive a very modest adjustment: 0.2%. Although that change is relatively small, it means that the “smoothing” provisions in last year’s budget deal do not apply—and, as the Wednesday Medicare report notes, premiums for some beneficiaries “need to be raised substantially,” up to nearly $150 per month.
Source: wsj.com

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

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Source: medicare.gov

More Medicare Information

If you live in Puerto Rico you will not receive Medicare Medical Insurance (Medicare Part B) automatically. You will need to sign up for it during your initial enrollment period or you will pay a penalty. To sign up, please call our toll-free number at 1-800-772-1213 (TTY 1-800-325-0778). You also may contact your local Social Security office. You can find your local Social Security office by using our Office Locator.
Source: ssa.gov

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

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

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

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

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Source: medicare.gov

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 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

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 Supplement Plan F

* A benefit period begins on the first day you receive services 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. ** NOTICE: When your Medicare Part A hospital benefits are exhausted, the insurer stands in the place of Medicare and will pay whatever amount Medicare would have paid for up to an additional 365 days as provided in the policy’s “Core Benefits.” During this time the hospital is prohibited from billing you for the balance based on any difference between its billed charges and the amount Medicare would have paid.
Source: bcbsil.com

How to compare Medigap policies

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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

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

Compare Medicare Supplement Plans Side by Side

Last but not least is the coverage you desire from your Medigap plan.  There are ten plans to choose from that are labeled Plan A – Plan N (plans E, H, I, and J are no longer offered).  Plan F is the most popular Medicare Supplement, because it offers the most comprehensive coverage on the market.  Plan G is a great plan because it also has extensive coverage, with lower premiums and rate increases than Plan F.  Another popular plan is Plan N, which has more cost sharing but lower premiums than the other Medigap policies. 
Source: medicareinsurancefinders.com

Comparison Chart of All 10 Medicare Supplement Plans & Policies

To view a more detailed description of benefits for a specific plan, select an option below: Medicare Supplement Plan A Medicare Supplement Plan B Medicare Supplement Plan C Medicare Supplement Plan D Medicare Supplement Plan E (no longer offered) Medicare Supplement Plan F Medicare Supplement Plan G Medicare Supplement Plan H (no longer offered) Medicare Supplement Plan I (no longer offered) Medicare Supplement Plan J (no longer ofered) Medicare Supplement Plan K Medicare Supplement Plan L Medicare Supplement Plan M Medicare Supplement Plan N
Source: medicaresupplementsolutions.com

Medicare Advantage vs. Medicare Supplement

10 types of Medigap plans are standardized in 47 states; each plan is labeled with a letter (such as Plan B). Once you decide which plan you want, you can compare different companies offering the same plan. For example, if you choose Plan B, you can look at the prices and any extra options that different companies might have for Plan B. You may also want to choose a health insurer you’re already comfortable with, or you can shop around for your best price — it’s up to you. You can use the plan comparison form on this page, or visit Medicare.gov.
Source: ehealthmedicare.com

Sterling Insurance :: Home

Posted by:  :  Category: Medicare

Sterling Insurance Company is located in Cobleskill, New York. Since 1895 we have been providing quality insurance protection to New Yorkers with an ever expanding array of product offerings. We are a mutual company which allows us to take a long term outlook and pro-actively respond to the needs of our policyholders. Today we insure over 100,000 New Yorkers. This website is designed to give you a better familiarity with Sterling Insurance Company but we also encourage you to visit an independent Sterling agent and get first hand professional advice on the kind of organization we are. We are confident you will be pleased with the insurance protection we can provide and would be honored to have your business.
Source: sterlingins.com

Compare Sterling Life Medicare Supplements

Medigap Companies: Admiral Life Insurance Aetna Life Insurance American Continental Insurance American National Life Insurance Anthem Life American Pioneer Life Insurance American Republic Insurance Bankers Fidelity Life Insurance Blue Cross and Blue Shield Central Reserve Life Insurance Christian Fidelity Life Insurance Combined Insurance Company Conseco Insurance Company Continental General Insurance Continental Life Insurance Company Equitable Life and Casualty Insurance Family Life Insurance Company Forethought Insurance Company Genworth Life Insurance Company Gerber Life Insurance Company Globe Life and Accident Insurance Golden Rule Insurance Company Great American Life Insurance Guarantee Trust Life Insurance Humana Insurance Company Lincoln Heritage Life Insurance Loyal American Life Insurance Marquette National Life Insurance Mutual of Omaha Insurance Company National States Insurance Company New Era Life Insurance Company Old Surety Life Insurance Company Pacificare Life Assurance Company Pennsylvania Life Insurance Company Philadelphia American Life Insurance Physician’s Life Insurance Company Provident American Life & Health Reserve National Insurance Company Royal Neighbors of America Sierra Health and Life Insurance Southwest Service Life Insurance Standard Life and Accident Insurance State Mutual Insurance Company Sterling Investors Life Insurance Sterling Life Insurance Company Unicare United American Insurance Company United Commercial Travelers (UCT) United National Life Insurance United of Omaha Life Insurance United Teacher Associates United World World Corp Insurance Company
Source: medigap360.com

Medicare Supplement, Life, Dental & Critical Condition Insurance

Sterling recognizes the vital role providers play as the critical link between patients and their health. Sterling treats providers with the respect they deserve with Medicare Supplement expertise, top-notch customer service, quick and accurate claims processing, and comprehensive tools to manage the administrative process.
Source: cigna.com

Sterling Investors Life Insurance

Founded in 1978 and located in Indianapolis, Indiana, Sterling Investors Life Insurance Company proudly serves the insurance needs to middle class America by providing valuable insurance protection across a broad range of insurance plans. We’re not the biggest so we work very hard everyday to make sure that our policyholders and agents across the country receive a level of service from us that always exceeds their expectations. We believe our company reflects the same conservative values as that of our regional surroundings.
Source: sterlinglifeco.com