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

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Source: medicare.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

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

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

The 10 hospitals with the largest decreases in readmissions penalties and the 10 with the largest increases, ranked by penalty percentage point changes. Based on the August, 2016 CMS release of readmissions adjustment factors for fiscal 2017 compared with FY 2016 data. Published August 15, 2016 on…
Source: modernhealthcare.com

The Rising Cost of Living Longer: Analysis of Medicare Spending by Age for Beneficiaries in Traditional Medicare

Posted by:  :  Category: Medicare

Consistent with other studies documenting higher costs for patients at the end of life, this analysis shows that Medicare per capita spending was nearly 4-times greater among beneficiaries who died in 2011, on average, than among those who lived the entire year.  Yet the analysis also shows that Medicare per capita spending among decedents declines with age, suggesting that patients, families, and providers may be opting for less intensive and less costly end-of-life interventions for beneficiaries as they grow older.  This possibility is consistent with the finding that average per capita spending on hospice services among beneficiaries in traditional Medicare increases with age, due to both a larger share of beneficiaries electing hospice at older ages and higher per capita hospice costs for older than younger Medicare beneficiaries who elect hospice care.
Source: kff.org

Saving Medicare from Itself > Publications > National Affairs

The consequences were immediate and dramatic. The annual growth of physician fees in America went from 3.8% in 1965 to 7.8% in 1966. In that same first year of Medicare’s existence, hospital costs increased by 21.9%; over the subsequent five years, they grew by an average of 14% each year. These figures flummoxed government forecasters, who had projected that growth in hospital costs would actually slow after the enactment of Medicare. Instead, costs continued to grow rapidly. When Medicare was enacted, the staff of the House Ways and Means Committee (which was responsible for estimating the program’s costs and effects, since the Congressional Budget Office had yet to be created) projected that its cost would grow from under $5 billion in its first year to $12 billion in 1990 — accounting for inflation — because they expected that hospital-cost growth would not exceed wage growth from 1975 onward. Instead, Medicare expenditures grew at roughly 2.4 times the rate of inflation over that period, and in 1990 reached not $12 billion but $110 billion. By 2000, the program cost $219 billion. Last year, it cost just over $520 billion. According to the Congressional Budget Office, if Medicare is not reformed, by 2020 it will cost about a trillion dollars a year.
Source: nationalaffairs.com

10 FAQs: Medicare’s Role in End

A: By and large, the public supports having doctors discuss end-of-life care issues with their patients, and having Medicare and private insurance cover these discussions (Figure 2).  A recent Kaiser Family Foundation survey found that about 9 in 10 adults (89 percent) say doctors should discuss end-of-life care issues with their patients, yet only 17 percent of adults say they have had such a discussion with their doctor or health care provider.  Among adults ages 65 and older, the share is somewhat higher (27 percent).  Among all adults who said they had not had a discussion with their doctor or other health care provider about end-of-life care wishes, half said that they would want one. The majority of adults (81 percent) say Medicare should cover discussions between doctors and patients about end-of-life treatment options—comparable to the share (83 percent) favoring private insurance coverage for similar conversations.
Source: kff.org

Regence Medicare Advantage Medical Policy and Review Process

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Medicare Advantage Medical Policies are the property of our Plans and their affiliated or subsidiary companies, but may be used for purposes related to the health care of a Medicare Advantage Plan member.  You are strictly prohibited from using Medicare Advantage Medical Policies for purposes not related to the health care of a Plan member, including but not limited to commercial use.
Source: regence.com

Regence Medicare Advantage Medical Policy and Review Process

Medicare Advantage Medical Policies identify the clinical criteria for determining when medical services are considered ‘reasonable and necessary’ (medically necessary).  Medicare Advantage plans are required by CMS to provide the same medical benefits to Medicare Advantage members as Original Medicare.  As such, whenever possible, Medicare Advantage Medical Policies are based on Medicare coverage manuals, National Coverage Determinations (NCDs), and Local Coverage Determinations (LCDs) when available.  If there is no applicable NCD or LCD for the service under review, then other evidence-based criteria may be applied.  In addition, each member’s unique, clinical situation is considered in conjunction with current CMS guidelines.
Source: regence.com

Regence BlueCross BlueShield MedAdvantage Plan Choices in Oregon

Available in Benton, Clackamas, Clatsop, Columbia, Coos, Curry, Douglas, Hood River, Jackson, Josephine, Lane, Lincoln, Linn, Marion, Multnomah, Polk, Tillamook, Wasco, Washington or Yamhill county in Oregon or Clark County in Washington
Source: ehealthlink.com

Regence BlueCross BlueShield MedAdvantage Plan Choices in Oregon

Regence MedAdvantage health insurance members can choose from a network of doctors, specialists and hospitals for their health care needs. You may use any health care doctor who is part of the network. You may also use doctors outside of the network but you may have to pay more for the services you receive.
Source: ehealthlink.com

Medicare Supplement Plan F

Posted by:  :  Category: Medicare

* 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. **This high deductible plan pays the same or offers the same benefits as Plan F after you have paid a calendar year $2110 deductible. Benefits from the high deductible Plan F will not begin until out-of-pocket expenses are $2110. 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 deductible.
Source: medigap360.com

Medigap Plans from the Experts in Medigap

We are committed to helping Americans, such as yourself, confidently choose the best Medigap plan. Our licensed insurance agents are paid a flat commission rate on all insurance carriers so that we can deliver 100% unbiased recommendations on the best insurance solution based on your unique health needs.
Source: gomedigap.com

Medicare Supplement Plan F

Medicare Supplement Plan F is generally regarded as the most comprehensive plan out of the 10 Medicare Supplement (Medigap) policies available in most states. Its extensive coverage makes this a popular plan for beneficiaries who want broader assistance with out-of-pocket costs in Original Medicare; however, this also means that premiums may be more expensive. Because Plan F covers most remaining hospital and doctor costs after Original Medicare (Part A and Part B) has paid its share, it’s possible for beneficiaries with this plan to not have any or minimal other hospital and medical expenses.
Source: ehealthinsurance.com

Medicare Supplement Plan F

They are denoted by the letters A through N. Because these plans are offered by private insurance companies, the cost and availability of each lettered plan may differ, but not the benefits.  In other words, all companies that offer, say Plan F, must offer the same standardized benefits. Not every insurance company, though, offers all ten plans.
Source: clearmedicaresolutions.com

Medicare Supplement Insurance Quote Engine

In addition to Medicare supplement insurance, we are pleased to be participating in the Medicare Advantage market. The Medicare Advantage policy is a low cost alternative to a Medicare supplement policy and is especially advantageous for those less than 65 years old. The Private Fee For Service (PFFS) is a type of Advantage plan that allows Medicare recipient to visit any doctor, any hospital, anywhere. Therefore, many Medicare recipients are well served by the lower cost Private Fee For Service plan.
Source: bestmedicaresupplement.com

Welcome to Maine Medicare Options!

Posted by:  :  Category: Medicare

The benefit to you is that I am a “One-Stop Shop.”   When you sit down with me we will review your specific needs and match you up with the plans that best meet those needs.  I will help you narrow down those choices to one plan by answering all your questions so you can make the best choice for you and feel confident knowing that you have chosen the right plan.  I will also help you enroll in the plan and as your agent, I will be there with you during the entire process of enrollment.  I am also available to you during the year any time you have questions or need direction.  Medicare is very complex and it is a great relief to know you have someone in your corner every step of the way.   Every year Medicare Advantage and Part D Prescription Drug plans can change and as your agent, I will talk with you or meet with you before your plan changes.  We will review all changes and if necessary help you to find a new plan that suits your needs best.  I will never pressure you or suggest you change plans.  That decision is always yours to make.   I am simply here as a guide to help you make an informed decision.  I am well respected among my peers and maintain a good reputation. I build meaningful relationships with the people I meet and offer exceptional customer service.
Source: mainemedicareoptions.com

About Maine SHIP: Medicare Assistance: Support in the Community: Office of Aging And Disability Services

If you have Medicare insurance, or expect to have it soon, you may have questions or need help to understand your Medicare benefits. Trained health insurance counselors are available throughout Maine to provide you information about Medicare and other health insurance issues. You can also learn about programs in Maine that help lower the cost of prescription drugs and other out-of-pocket medical expenses. SHIP services are free, confidential and available to older people and people who have Medicare because of a disability. SHIP Counselors do not sell insurance or recommend policies.
Source: maine.gov

Southern Maine Agency on Aging

One-on-one health insurance counseling appointments can be scheduled after you have attended a Welcome to Medicare Seminar. These appointments will pair you with a trained State Health Insurance Program (SHIP) counselor who is either a Southern Maine Agency on Aging staff member or a highly-trained volunteer. All counselors are highly-skilled and trained to provide support and assistance to Medicare beneficiaries in understanding their plan choices. All Medicare beneficiaries are encouraged to review their plans yearly. One-on-One Medicare Appointments are offered at the following locations:
Source: smaaa.org

Medicare Home Health Compare Results

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Source: medicare.gov

2015 Hospice Billing Seminar l Medicare Training & Consulting

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Medicare has finalized the New Cost Report forms. All Providers must use for the 2015 Cost Reporting Year. Providers must track costs by type of service (Routine, Continuous,  etc.) throughout the year. CMS will implement new changes to approved software, which require on-going changes to payroll and financial tracking systems.  
Source: medicareconsulting.net

Medicare Billing, Consulting, Complaince, Training Ohio

Lutheran Homes Society, Inc.’s experience with ECS Solutions has been wonderful! We engaged them to help with reconciliation and back billing projects. These projects went so well that we now also utilize them for billing of our Medicare, Medicaid and Insurance claims. The staff is very knowledgeable and, with the ever-changing health care billing environment, we know that ECS will be on top of those changes and that our claims will still be billed and paid timely. One of the greatest benefits of utilizing ECS is that we no longer have to struggle to find well-trained and experienced billers at the individual facility level. I would recommend that you consider utilizing ECS to help your facility stay on top of evolving reimbursement issues and reduce your outstanding accounts receivable balances.
Source: ecssolutionsinc.com

Corporate Compliance Training, Hospital, Medicare & Healthcare Billing, Corporate Integrity Agreement Training

In today’s environment, medical personnel cannot afford to take risks with lawsuits and other potentially devastating consequences that can be associated with failing to comply with internal standard operating procedures. Along with potentially costing millions of dollars, allegations of wrongdoing can damage an organization’s reputation. Internal guidelines are set to protect healthcare providers from future lawsuits or penalties, meaning that healthcare and corporate compliance are inexorably linked and critical for an organization’s continued success.
Source: hccs.com

Billing Medicare for Depo

My OB/Gyn office has had the same issue with medicare and depo. Check the medical records to make sure exactly why patient is receiving the injections. If the patient is truly receiving the depo shots for contraception then you would have no choice but to bill HCPCS code J1055 with the contraceptive management diagnosis. However, some physicians give a depo shot to a patient to help manage/reduce abnormal bleeding or heavy menstrual cycles. In that case you would bill J1051 for the depo with the medical issue diagnosis. In either case, I would hope the physicians office completed an ABN form and had patient sign acknowledging that I may not be covered and she would be responsible if medicare does not cover. If the physicians office did have complete the ABN be sure you bill with a "GA" mod to let medicare know they can process to patient responsibility if not a covered item. Hope this helps you.
Source: aapc.com

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

Your Medicare Supplemental Insurance Information – Medicare Advantage

* MedicareSupplemental.com provides a free guide written and distributed by the Centers for Medicare & Medicaid Services titled “Choosing a Medigap Policy: A Guide to Health Insurance for People on Medicare”. This guide is also available for free on the official Medicare.gov website. By submitting this form, you are also requesting that a licensed insurance agent contact you by email or telephone.
Source: medicaresupplemental.com

Medicare Supplemental Insurance — Which policy is best?

Our recommendation: After picking the benefit combination (Plan A through L) that best suits your needs, buy the issue-age or community-rated Medigap policy with the lowest premium. Even though they are a bit more expensive at the start, your premiums won’t go up every year just because you get older. (AARP’s Medigap plans use a combination of issue-age and community-rated methods; their premiums don’t increase as you get older, but their younger retirees do receive a discount.)
Source: todaysseniors.com

Medicare Supplemental Insurance by 1

 A Medicare Supplement Plan, or Medigap, is a type of medicare health insurance that is sold by private insurance companies and is specifically designed to help you by filling in the “gaps” of Original Medicare. In order to purchase a Medigap plan you must be enrolled in Medicare Part A and B, and you will continue to pay your monthly Part B premium. You would then pay your Medigap premium and as long as your premium gets paid you will have the benefit of guaranteed renewable coverage. What this means is that the insurance company cannot cancel your policy.   There are several different plan types available to consider, but it is important to note that Medigap policies are “standardized.” This means that they are required to abide by the Federal and State laws that are put in place to protect you. The standardized policies must provide you with the same benefits no matter what company sells them and generally the only difference from company to company, if it is the same plan type, is the cost. Many couples would like to be covered under the same policy, but you and your spouse must each purchase your own individual policies. In some instances you might be allowed to purchase a Medicare Supplement plan that is guaranteed issue without any medical underwriting! This means that you cannot be denied coverage. 
Source: youandmedicare.com

Affordable Health Insurance in Ohio

Posted by:  :  Category: Medicare

As you become eligible for Medicare, you’ll begin making important decisions about your healthcare coverage. SummaCare can help you sort through all the details and answer your questions. Learn more about our Medicare plans today.
Source: summacare.com

SilverSneakers Medicare Programs

So, what exactly is SilverSneakers?  SilverSneakers is essentially a gym membership or fitness club membership to participating centers across the country.  You can find participating gyms by going to www.silversneakers.com and typing in your zip code.  You can find out if your Medicare plan offers Silver Sneakers by calling 1-888-423-4632.  Here are some of the features offered by SilverSneakers.
Source: medicare-plans.net

Gateway Health Medicare Assured Medicare Advantage Plans with Part D (Prescription Drug) Coverage

The following Gateway Health Medicare Assured plans offer Medicare Advantage and Part D coverage to Ohio 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

AmeriChoice Health Insurance Company Review

Posted by:  :  Category: Medicare

AmeriChoice provides comprehensive low or no cost insurance to those who qualify. Because your state wants all children to have healthcare, even if you are not a low-income family, your children can qualify for the low cost insurance option as long as they are in school (outside of college). The low cost option is typically based on your income; however, the out of pocket expense usually maxes out at $20 per month. This is a very affordable option for families that make too much to qualify for government programs, but cannot afford health insurance for their children.
Source: healthinsuranceproviders.com

Medicare Information, Help, and Plan Enrollment

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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

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 Insurance Plans & Medigap Plans and Rates for
2011. See Plan Chart for AL, AR, AZ, CO, FL, GA, IA, ID, KS, KY, LA, MD, MI, MO, MN, MS,
NC, NE, NM, OH, OK, SC, TN, TX, VA & WV. Medigap Insurance Plans including the
Popular Plan F & G

Year after year we have found Medicare Supplement Plan F or Medicare Supplement Plan G to be the best value for the dollar. The new Plan N is a great alternative to a Medicare Advantage plan.  Plan N might be recommended depending on which state you live in and how much the supplement cost in relation to available Medicare Advantage plans. A plan N will provide more coverage and a very reasonable premium. In Florida we have the lowest rate for plan F & plan N. See the Medicare Supplement Plan chart below. In general, the higher you go up in the plan chart the more Gaps the plan fills. Medicare Supplement Plan F is the most comprehensive supplement plan and there is not a better plan than F. Most people will select a Plan F. However, depending on your personal situation there may be a more cost efficient choice.
Source: themedicarechannel.com

Medicare Advantage and Prescription Drug Plan Fact Sheet

Kaiser Family Foundation describes MA payments as follows: “ Since 2006, Medicare has paid plans under a bidding process….The ACA of 2010 revised the methodology for paying plans and reduced the benchmarks…Reductions in benchmarks will be phased-in over 2 to 6 years between 2012 and 2016.  By 2017, when the new benchmarks are fully phased-in, the benchmarks will range from 95% of traditional Medicare costs in the top quartile of counties with relatively high per capita Medicare costs (e.g., Miami-Dade), to 115% of traditional Medicare costs in the bottom quartile of counties with relatively low Medicare costs (e.g., Boise).The ACA specified that plans with higher quality ratings would receive bonus payments added to their benchmarks, beginning in 2012.  The ACA also reduced rebates for all plans, but allowed plans with higher quality ratings to keep a larger share of the rebate than plans with lower quality ratings.  A CMS demonstration was implemented in 2012 that superseded bonuses specified by the ACA, raised the size of the bonus payments, and increased the number of plans that would receive bonus payments, providing an additional $8 billion in bonuses between 2012 and 2014.” 8
Source: medicarehmo.com