Compare Medicare Advantage & Supplemental Plans

Posted by:  :  Category: Medicare

Medicare Advantage insurance is offered by private insurance companies with a Medicare contract, and replaces Original Medicare Part A and Part B. You must continue to pay your Part B premiums. Medicare Advantage plans typically offer additional benefit options and have less cost-sharing than Original Medicare, and you may have to pay a monthly premium in return for the extra benefits. Medicare Advantage plans come in a variety of formats, such as HMO, PPO and PFFS plans, as well as special needs plans. Medicare beneficiaries can enroll in Medicare Advantage plans if they have Medicare Part A and Part B, but only during designated enrollment periods. These enrollment periods change from time-to-time, so please call us to get the most-up-to-date information.
Source: medicaresolutions.com

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

Medical Billing & Scheduling Software: Physician Practice Management Software for Small & Medium Offices by EZClaim

Posted by:  :  Category: Medicare

After 17 years of working in a medical setting I decided to start my own billing service. I was at a complete loss as to which billing program to purchase until I found EZClaim. I fell in love with the functional ease of EZClaim and the unbeatable support. I have used EZClaim for 13 years and submit my claims electronically and work in the Cloud. T. Whaley, Billing Solutions
Source: ezclaim.com

Medicare, Medicaid and Medical Billing

When a Part A claim is processed by Medicare, Medicare pays the provider directly for the service rendered by the provider. On the other hand, in a Part B claim, who pays depends on who has accepted the assignment of the claim. If the provider accepts the assignment of the claim, Medicare pays the provider 80% of the cost of the procedure, and the remaining 20% of the cost is passed on to the patient. You should recognized that 80-20 breakdown: it’s a classic example of coinsurance.
Source: medicalbillingandcoding.org

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

Billing 90670 to Medicare

New guidelines have come out that a Prevnar 13 should be given to any medicare patient a year after they have received the Pneumovax. Then 6 months after the Prevnar 13 is given, they should be given another Pneumovax booster. This is a recent bulletin from medicare, however there is no information on CMS as to how to bill or what the reimbursement rate is for it. If anyone has any insight to share on the proper way to do this and the appropriate reimbursement for this, an information would be greatly appreciated.
Source: aapc.com

Medicare Prior Authorization Pilot Project

Every commenter mentioned that an initiative to prevent fraud and abuse should be targeting agencies already under suspicion of such activities. A territorial approach to testing the prior authorization model simply creates additional burden on honest, well-intentioned HHA’s that follow the rules. There are 3 comments so far, all from Florida and all strongly against the pilot. It’s a hard knock life for home health agency providers in Florida as they are seeing the 3’rd proposed pilot project in their state. Currently, Florida home health agencies are already subject to the Value-Based Purchasing model that started January 1, 2016 (described in more detail here), and the Comprehensive Care for Joint Replacement Model effective April 1, 2016 (described further here).
Source: fasternotes.com

90714 & Medicare Billing

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Source: aapc.com

How to Reform Medicare: First Stage to Fix the Current Program

Posted by:  :  Category: Medicare

[5]The significant differences in official long-term projections, including projections of the program’s unfunded liability, reflect the differences in agency assumptions, particularly about the likelihood of the continuation of current law. The Medicare Trustees and the Congressional Budget Office (CBO) are required to make projections under current law, which assumes, for example, that the large Medicare Part A payment reductions are sustainable and that the projected 29.4 percent reduction in Medicare physician payment will be implemented in 2012. The Office of the Actuary in the Centers for Medicare and Medicaid Services (CMS) makes projections based on the premise that key elements of current law are simply “unworkable.” See John D. Shatto and M. Kent Clemens, “Projected Medicare Expenditures Under an Illustrative Scenario with Alternative Payment Updates to Medicare Providers,” Centers for Medicare and Medicaid Services, Office of the Actuary, May 13, 2011, at https://www.cms.gov/ReportsTrustFunds/downloads/2010TRAlternativeScenario.pdf (September 19, 2011).
Source: heritage.org

Annual Statistical Supplement, 2011

Beginning January 1, 2006, upon voluntary enrollment in either a stand-alone PDP or an integrated Medicare Advantage plan that offers Part D coverage in its benefit, subsidized prescription drug coverage. Most FDA-approved drugs and biologicals are covered. However, plans may set up formularies for their drug coverage, subject to certain statutory standards. (Drugs currently covered in Parts A and B remain covered there.) Part D coverage can consist of either standard coverage or an alternative design that provides the same actuarial value. (For an additional premium, plans may also offer supplemental coverage exceeding the value of basic coverage.) Standard Part D coverage is defined for 2006 as having a $250 deductible, with 25 percent coinsurance (or other actuarially equivalent amounts) for drug costs above the deductible and below the initial coverage limit of $2,250. The beneficiary is then responsible for all costs until the $3,600 out-of-pocket limit (which is equivalent to total drug costs of $5,100) is reached. For higher costs, there is catastrophic coverage; it requires enrollees to pay the greater of 5 percent coinsurance or a small copay ($2 for generic or preferred multisource brand and $5 for other drugs). After 2006, these benefit parameters are indexed to the growth in per capita Part D spending (see Table 2.C1). In determining out-of-pocket costs, only those amounts actually paid by the enrollee or another individual (and not reimbursed through insurance) are counted; the exception is cost-sharing assistance from Medicare’s low-income subsidies (certain beneficiaries with low incomes and modest assets will be eligible for certain subsidies that eliminate or reduce their Part D premiums, cost-sharing, or both) and from State Pharmacy Assistance Programs. A beneficiary premium, representing 25.5 percent of the cost of basic coverage on average, is required (except for certain low-income beneficiaries, as previously mentioned, who may pay a reduced or no premium). For PDPs and the drug portion of Medicare Advantage plans, the premium will be determined by a bid process; each plan’s premium will be 25.5 percent of the national weighted average plus or minus the difference between the plan’s bid and the average. To help them gain experience with the Medicare population, plans will be protected by a system of risk corridors, which allow Part D to assist with unexpected costs and to share in unexpected savings; after 2007, the risk corridors became less protective. To encourage employer and union plans to continue prescription drug coverage to Medicare retirees, subsidies to these plans are authorized; the plan must meet or exceed the value of standard Part D coverage, and the subsidy pays 28 percent of the allowable costs associated with enrollee prescription drug costs between a specified cost threshold ($250 in 2006, indexed thereafter) and a specified cost limit ($5,000 in 2006, indexed thereafter).
Source: ssa.gov

2011 MLN Matters Articles

The page could not be loaded. The CMS.gov Web site currently does not fully support browsers with “JavaScript” disabled. Please enable “JavaScript” and revisit this page or proceed with browsing CMS.gov with “JavaScript” disabled. Instructions for enabling “JavaScript” can be found here. Please note that if you choose to continue without enabling “JavaScript” certain functionalities on this website may not be available.
Source: cms.gov

F & J Deductible Announcements

Medicare supplemental (Medigap) Plan F can be sold with a high deductible option. Before June 1, 2010, Medigap Plan J could also be sold with a high deductible. Effective January 1, 2016, the annual deductible amount for these two plans is $2180, the same amount as for 2015. The deductible amount for the high deductible version of plans F and J represents the annual out-of-pocket expenses (excluding premiums) that a beneficiary must pay before these policies begin paying benefits. CMS updates the deductible amount for plans F and J each year, after release of the August Consumer Price Index for all Urban Consumers (CPI-U) figures by the Bureau of Labor Statistics, which generally occurs in mid-to late September.
Source: cms.gov

What’s in Store for Medicare’s Part B Premiums and Deductible in 2016, and Why?

The absence of a COLA affects the amount of the Medicare Part B premium charged to enrollees because it triggers the broader application of a provision in the Social Security law known as the hold-harmless provision. In a year where the Social Security COLA is insufficient to cover the amount of the Medicare Part B premium increase for an individual, the law prohibits an increase in the Part B premium that would result in a reduction in that individual’s monthly Social Security benefits from one year to the next. (For an example of how the hold-harmless provision works in a typical year with a Social Security COLA, see Appendix B.) The hold-harmless provision affects a different number of beneficiaries each year, depending on the level of their Social Security benefits, the size of the COLA, and the increase in the Medicare Part B premium. In years with no COLA, a majority of beneficiaries are protected by the hold-harmless provision.
Source: kff.org

Medicare Advantage Plans in Sterling Heights, Michigan

Posted by:  :  Category: Medicare

Below are Medicare Advantage plans available to residents of Sterling Heights, Michigan. 12 carriers offer 33 plans throughout the city of Sterling Heights. Residents may choose plans from multiple carriers. This data has been made available by the Centers for Medicare & Medicaid Services (CMS) and is for informational purposes only. Some data may be inaccurate or incomplete. Please note that plans can vary by city, county, and state and all plans listed may not be available in all areas. To speak to an advisor and find the Medicare Advantage plan in Sterling Heights that is right for you complete the form at the top of the page.
Source: online-health-insurance.com

Sterling Medicare Supplemental Insurance Reviews

Sterling Option #1 is the first Medicare Advantage plan that allows holders to combine Medicare Supplemental Services and traditional Medicare. This ultimately translates into seeing your physician and allowing the bill to be sent to Sterling. Sterling will pay the bill and Medicaid will be notified of their portion, which then pays Sterling. This subsequently saves lots of time and headaches with filing claims with Medicaid and Sterling. Sterling basically handles everything while making the process as simple as possible for you. Your only concern will be paying the premiums for your Sterling Medicare Supplemental Insurance plan as well as for the Medicare Part B plan.
Source: ihealthcoalition.org

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 Advantage Plans in Sterling County, Texas

Below are Medicare Advantage plans available to residents of Sterling county, Texas. 2 carriers offer 21 plans throughout the county of Sterling. Residents may choose plans from multiple carriers. This data has been made available by the Centers for Medicare & Medicaid Services (CMS) and is for informational purposes only. Some data may be inaccurate or incomplete. Please note that plans can vary by city, county, and state and all plans listed may not be available in all areas. To speak to an advisor and find the Medicare Advantage plan in Sterling county that is right for you complete the form at the top of the page.
Source: online-health-insurance.com

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

Healthcare business news, research, data and events from Modern Healthcare

Posted by:  :  Category: Medicare

The 47 largest accountable care organizations, ranked by a range of estimated Medicare lives.Includes rank, ACO, State and range of estimated Medicare lives (e.g. 75,000 – 100,000). Also, a separate list of 50 states ranked by number of ACOs. Published August 8, 2016 on page 34, 35.
Source: modernhealthcare.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

Readmissions Reduction Program (HRRP)

Aggregate payments for excess readmissions = [sum of base operating DRG payments for AMI x (excess readmission ratio for AMI-1)] + [sum of base operating DRG payments for HF x (excess readmission ratio for HF-1)] + [sum of base operating DRG payments for PN x (excess readmission ratio for PN-1)] + [sum of base operating DRG payments for COPD x (excess readmission ratio for COPD-1)] + [sum of base operating payments for THA/TKA x (excess readmission ratio for THA/TKA -1)]
Source: cms.gov

California Health Advocates

We provide accurate, unbiased information about Medicare benefits and long-term care for Californians. Learn how Medicare works, ways to supplement your coverage, about low-income programs, prescription drugs and your long-term care options.
Source: cahealthadvocates.org

More Medicare Information

Posted by:  :  Category: Medicare

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

The Agency For Health Care Administration

Posted by:  :  Category: Medicare

Welcome to the website for the Florida Agency for Health Care Administration. Our mission is "Better Health Care for All Floridians." As champions of that mission, we are responsible for the administration of the Florida Medicaid program, licensure and regulation of Florida’s health facilities and for providing information to Floridians about the quality of care they receive. Every day, we look for ways to improve health care in Florida. We’ve built strong partnerships with other agencies and continue to develop relationships with stakeholders at all levels in communities around the state. The Agency for Health Care Administration would not be able to effectively carry out its mission without your help. Thank you for your partnership and for the opportunity to serve you. The Agency places the utmost importance on the safe and secure handling of all protected health information. For more information, please review our Notice of Privacy Practices.
Source: fl.us

Breaking News, Sports, Weather & More

Former Heisman Trophy winning quarterback Tim Tebow is making another comeback — this time in baseball. The former University of Florida quarterback who was drafted by the Denver Broncos and also played for the New York Jets told ESPN he has been working out and plans on holding an open workout for Major League Baseball teams.
Source: miamiherald.com

Florida Department of Children and Families

This may result in fines of up to $250,000, a prison term or both, if you are convicted of public assistance fraud. In addition you will not be able to get benefits for 12 months the first time, 24 months the second time, and permanently the third time that you provide false or inaccurate information.
Source: myflorida.com

California Health Advocates

Posted by:  :  Category: Medicare

We provide accurate, unbiased information about Medicare benefits and long-term care for Californians. Learn how Medicare works, ways to supplement your coverage, about low-income programs, prescription drugs and your long-term care options.
Source: cahealthadvocates.org

Medicare Advantage California

*All information submitted is private and not shared with third parties. We have a no spam or solicitation policy. All data is used expressly by medicareadvantagecalifornia.com and qualified associated medicare brokers to provide consumers with requested California Medicare Advantage information and assistance. By clicking on ‘Submit’, you consent to receiving a phone call and/or email from a licensed insurance representative regarding Medicare Advantage, Medicare Supplement and / or Medicare Drug Plans. When calling our toll free number you will be connected to a qualified licensed agent to assist you.
Source: medicareadvantagecalifornia.com

Medigap Insurance in California

"Thanks again for your help – I had absolutely no idea how to get this done when I got up this morning. You’ve made it remarkably easier than I expected. I hope you’re not stuck at the office all night…"
Source: californiamedigap.com

California Medicare Advantage Plans with Part D (Prescription Drug) Coverage

The plans below offer Medicare Advantage and Part D coverage to California residents. Medicare Advantage plans, also known as Medicare Part C, are alternatives to original Medicare. These plans help cover the costs of services provided by hospitals, doctors, lab tests and some preventive screenings. These plans’ Part D component helps cover prescription drugs. Even if a plan’s monthly premium is $0, you would still pay the equivalent of the original Medicare premium. Not all plans shown here will be available to you; enter your zip code to see plans in your area. You can read about whether Medicare Advantage is right for you. If you only want plans with drug coverage, browse Prescription Drug (Part D) Plans.
Source: usnews.com

Medicare Information, Help, and Plan Enrollment

Posted by:  :  Category: Medicare

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

Department of Human Services

In 2015, nearly 47,300 seniors and caregivers received information and assistance by calling 800-792-8820. Another 170,000 callers reached their county offices on aging, including an estimated 75,000 who used the ADRC toll-free number.
Source: nj.us

Medicare.gov Nursing Home Compare

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Source: medicare.gov