Medicare Health Insurance

Posted by:  :  Category: Medicare

When you know you’re covered financially for things like prescriptions, doctor visits, tests and procedures, we’re doing our job. But being a Blues member comes with extra perks, too. You get discounts on groceries, health clubs, travel and more. You can read more about these added benefits below.
Source: bcbsm.com

Health First Colorado (Colorado's Medicaid Program)

Posted by:  :  Category: Medicare

See a full list of benefits and co-payments in the Health First Colorado Benefits & Services Overview and learn more about your coverage and how to use it in the latest Health First Colorado Member Handbook.
Source: colorado.gov

Colorado Medicaid: eligibility, enrollment and benefits

One of the Affordable Care Act’s primary strategies for reducing the uninsured rate is Medicaid expansion to cover low-income, non-elderly adults without dependent children. Medicaid expansion was a required element of the ACA as originally written. However, a coalition of states challenged Medicaid expansion and several other provisions of the ACA, and the case ended up before the Supreme Court in 2012. While the Court rejected most of the challenges, it did rule that Medicaid expansion was optional.
Source: healthinsurance.org

2016 Medicare Part B Premium Spike

Posted by:  :  Category: Medicare

As problematic as the uneven application of the premium increase is, the evidence suggests that perhaps Congress was trying to solve the wrong problem with the Hold Harmless provision. In recent years there has been a substantial shift in the way medical care is provided. An emphasis on early screenings and prevention has moved patients from Part A-covered emergency rooms to their doctors’ offices. New drugs and the rising industry of outpatient clinics have moved patients from hospital beds to home recovery. And when the time comes, a preference for home health care or hospice care has replaced expensive end of life inpatient treatment. These are all demonstrated shifts from premium-free Part A services, to Part B covered care. Though health care costs are undoubtedly rising for many reasons, including the graying of the boomer generation, much of the increase in Part B costs may be attributable to positive gains in the health care industry since 1988 and earlier. Rather than encouraging continued use of expensive and less efficient hospital services, Congress should incentivize, not punish, increased reliance on these Part B covered services.
Source: americanactionforum.org

Medicare Part B Premium History

Part B premium rates are based on the projected cost to the federal government and Congress, an unpredictable factor. Historically, premiums go up each year. For example, Medicare Part B cost recipients $5.30 in 1970. By 1973, it was up to $6.30, though it was reduced to $5.80 in July and $6.10 in August that year. The premiums continued to increase and reached $31.90 per month in 1989. That rate came from the Medicare Catastrophic Coverage Act of 1988, a change that was intended to expand the program to cover some prescription medications and reduce out-of-pocket costs. It was repealed in 1989.
Source: ehow.com

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

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 Advantage Plans By State, Plan Comparison

Aetna Medicare is a PDP, HMO, PPO plan with a Medicare contract. Our SNPs also have contracts with State Medicaid programs. Enrollment in our plans depends on contract renewal. See Evidence of Coverage for a complete description of benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by location. ©2015 Aetna Inc. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, formulary, pharmacy network, provider network, premium and/or copayments/coinsurance may change on January 1 of each year. Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next. Our dual-eligible Special Needs Plan is available to anyone who has both Medical Assistance from the state and Medicare. Premiums, copays, coinsurance and deductibles may vary based on the level of Extra Help that you receive. Please contact the plan for further details. You must continue to pay your Medicare Part B premium. The Part B premium is covered for full-dual members. This information is available for free in other languages. Please call our customer service number at 1-844-233-1938 (TTY: 711) OR Coventry Health Care at 1-877-988-3589 (TTY: 711), 8 a.m. to 8 p.m., seven days, from October 1 – February 14; 8 a.m. to 8 p.m. Monday – Friday, from February 15 – September 30. Esta información está disponible en otros idiomas de manera gratuita. Comuníquese con Servicios al Cliente al 1-844-233-1938 (TTY: 711), de 8 am a 8 pm, siete días a la semana, desde el 1º de octubre hasta el 14 de febrero, y de 8 am a 8 pm, de lunes a viernes, desde el 15 de febrero hasta el 30 de septiembre. Medicare beneficiaries may also enroll in Coventry plans through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov. For mail-order, you can get prescription drugs shipped to your home through the network mail-order delivery program. Typically, mail-order drugs arrive within 7 to 14 days. You can call First Health Part D at 1-844-233-1938 (TTY: 711), 8 a.m. to 8 p.m., local time, seven days, from October 1 – February 14; 8 a.m. to 8 p.m. Monday – Friday, from February 15 – September 30, if you do not receive your mail-order drugs within this timeframe. Members may have the option to sign-up for automated mail-order delivery. Cost sharing for members who get “Extra Help” is the same at preferred and network pharmacies. The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary. Participating physicians, hospitals and other health care providers are independent contractors and are neither agents nor employees of Aetna. The availability of any particular provider cannot be guaranteed, and provider network composition is subject to change. This material is for informational purposes only and is not medical advice. Health information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professional. Contact a health care professional with any questions or concerns about specific health care needs. Providers are independent contractors and are not agents of Aetna. Provider participation may change without notice. Aetna is not a provider of health care services and, therefore, cannot guarantee any results or outcomes. The availability of any particular provider cannot be guaranteed and is subject to change. Information is believed to be accurate as of the production date; however, it is subject to change. For more information about Aetna plans, refer to www.aetnamedicare.com
Source: coventryhealthcare.com

Medicare Supplement Comparison

Medicare Supplement policyholders may not go unscathed from the ongoing changes to Medicare. The decrease in the pool of healthcare providers who will accept Medicare in 2016 will limit the policyholder’s options. Reimbursement rates may also affect Medicare Supplement plans going forward with healthcare providers charging Part B excess charges to remedy situation to some extent. Along with the increase to Medicare Part B deductible may cause Medigap providers to increase the premiums for Plan F, and Plan G, which covers all or so of medical costs, more than what they would be normally raised.
Source: medicarehealthinsurancefacts.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 Comparison Chart

Although there are several plans to choose from, comparing and contrasting Medicare Supplement Plans (also called Medigap) is relatively simple. The Centers for Medicare and Medicaid Services (CMS) has designed all Medicare Supplement Plans currently available. There are a total of 10 plans, and they are set up in a letter system ranging from “Plan A” to “Plan N”. All 10 Medigap plans are “Standardized”, meaning if you compared one particular letter plan, with another plan of the same letter offered by a different insurance company, the benefits would be identical. The only difference between companies is the price they charge.
Source: medicaresupplementsolutions.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

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

How Medicare Advantage Plans work

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

Things to know about Medicare Advantage Plans

Medicare Advantage Plans have a yearly limit on your out-of-pocket costs for medical services. Once you reach this limit, you’ll pay nothing for covered services. This limit may be different between Medicare Advantage Plans and can change each year. You should consider this when choosing a plan.
Source: medicare.gov

Medicare Advantage Plans for 2016

Not everyone is going to need an Advantage plan, nor will everyone benefit from such a plan. It all depends on what your medical needs are and how well basic Medicare covers you for them. Medicare subscribers or anyone looking into Medicare Advantage plans should also be careful about the plan and network they choose. They might end up with a network that doesn’t have a partnering healthcare facility anywhere in the subscriber’s area.
Source: medicareadvantageplansfor2016.com

Compare Medicare Advantage Plans for 2016

Because the more expensive supplements can almost completely eliminate out-of-pocket health expenses, they may help some beneficiaries save money in the long run. The interesting thing to note is that the two supplements that are the most expensive, Plan F and C, are also the most commonly purchased. This might be surprising, but for some beneficiaries, the price of the premium is low when compared to the cost of the deductibles and copays that the supplement might cover for them.
Source: medicareadvantageplans2016.net

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

Medicare Advantage Plans in Michigan

Medicare Advantage plans are a lot like the health insurance you may have had before becoming eligible for Medicare. You can choose a complete insurance package with the convenience of one ID card for all services.
Source: bcbsm.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 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

The Facts on Medicare Spending and Financing

A number of changes to Medicare have been proposed that could help to address the health care spending challenges posed by the aging of the population, including: restructuring Medicare benefits and cost sharing; eliminating “first-dollar” Medigap coverage; further increasing Medicare premiums for beneficiaries with relatively high incomes; raising the Medicare eligibility age; shifting Medicare from a defined benefit structure to a “premium support” system; and accelerating the ACA’s delivery system reforms. At the same time, changes have been proposed to improve coverage under Medicare in order to limit the financial burden of health care costs on older Americans and younger beneficiaries with disabilities, though such changes would likely require additional spending. In addition to these potential changes, which would affect future spending levels, revenue options could also be considered to help finance care for Medicare’s growing and aging population.
Source: kff.org

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

Medicare.gov Nursing Home Compare

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

Where Orlando Turns First For Breaking News, Weather, and Traffic

Posted by:  :  Category: Medicare

This makes me so ‘meowy’ sad.A cat named Little Andrew is breaking hearts across the internet after his owner, Reddit user abernha3, posted a photo showing the kitty appearing to hold his owner’s hand while they take their final trip to the veterinarian.
Source: news965.com

Unique Physician Identification Number (UPIN) Validation

Posted by:  :  Category: Medicare

Section 9202 of the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA85) requires that Centers for Medicare & Medicaid Services (CMS) establish an UPIN for each practitioner who provides services for which payment is made under Medicare. Once a practitioner enrolls with Medicare, the information is transferred to National Heritage Insurance Company (NHIC) who then issues a UPIN. The UPIN enables CMS to collect and combine payment and utilization information for an individual practitioner.
Source: hipaaspace.com

Doctor UPIN Answers Here!

The Doctor UPIN numbers are approved for public release in the Centers for Medicare & Medicaid Services or CMS System of Records. The file has quarterly updates. It is important to note that each Physician may only have one Doctor UPIN number assigned to them.
Source: doctorupin.com

How to Find a Upin Number

The Unique Physician Identification Number, or UPIN, is a reference number used by Medicaid and Medicare to identify physicians, as well as some nurse practitioners and other health care professionals, for billing purposes. Medicare stopped using the UPIN in 2007, and replaced it with the National Provider Identifier, or NPI. The UPIN directory is still available from the Center for Medicaid & Medicare Services, or CMS. You can also search for a practitioner’s UPIN using online search tools.
Source: ehow.com

Comprehensive Care for Joint Replacement Model

Posted by:  :  Category: Medicare

Every year during the approximate five performance years of this model, CJR hospitals will receive separate episode target prices for MS-DRGs 469 and 470, reflecting the differences in spending for episodes initiated by each MS-DRG. CMS will also use a simple risk stratification methodology to set different target prices for patients with hip fractures within each MS-DRG. All providers and suppliers are paid under the usual payment system rules and procedures of the Medicare program for episode services throughout the year. At the end of a model performance year, actual spending for the episode (total expenditures for related services under Medicare Parts A and B) is compared to the Medicare target episode price for the responsible hospital. Depending on the participant hospital’s quality and episode spending performance, the hospital may receive an additional payment from Medicare or be required to repay Medicare for a portion of the episode spending.
Source: cms.gov

Replacement of Life Insurance and Annuity Policies

Replacing an existing life insurance or annuity policy may not be in your best interest, or your decision could be a good one. You will pay acquisition costs and there may be surrender costs deducted from your existing policy. You may be able to make changes to your existing policy to meet your insurance needs at less cost. A policy loan will reduce the value of your existing policy and the amount paid upon your death. You should make a careful comparison of the costs and benefits of your existing policy and the proposed policy. You can ask the company or agent that sold you your existing policy to provide you with information concerning it. This may include an illustration of how your existing policy is working now and how it would perform in the future based on certain assumptions. Illustrations should not, however, be used as a sole basis to compare policies. Ask for and retain all sales material used by the agent in the sales presentation. Be sure you are making an informed decision.
Source: idaho.gov

Hip Replacement and Medicare coverage??? (medical, plan, hospital, doctor)

Barb, I had a total hip replacement on the left side last last June 2012 and wish I had done it sooner! I researched the surgeons who only do the anterior approach. It is much less invasive, zero chance of dislocation (unless you really mess up yourself by pivoting with your foot flat on the floor), not as much blood loss or complications etc., and a much easier recovery. I was in the hospital only 3 days, went to a rehab place for 5 days, but it was an awful place and I was not getting any PT etc., so I checked out of there and went home. Did not have any family support or care at home, except for the physical therapy (Medicare covers) at home, probably 9 times, I forget. Then outpatient PT to which I drove myself there. Was offered home health care, but didn’t need or want it, was doing fine after 3 weeks and driving. Look up doctors who specialize in the anterior method. Smaller incision high on the hip, no muscles are cut etc., excellent way to go. Mine is ceramic and titanium, they don’t do metal on metal anymore. With the old method you have a lot of strict precautions. Now I need to have the right hip done (which is now bone on bone, yikes), and will schedule it for March or so right here at home in NC; that way I’m good to go for the spring and summer best weather; and I know what to expect. I won’t go to any rehab/nursing center, better off at home with PT at the house. Those places are awful. Actually, the one I went to did some fraudulent Medicare billing and I’ve reported them. I never once got PT and they billed something like $1700 for PT which I never got, and something ridiculous for OT (occupational therapy which I never got). I had no choice about where to go for rehab, it was chosen on a first come first serve basis. (I did not have it done here in NC, had it done up north to be near family. haha.) So depending on where you live, if you want to go to rehab, visit the places and make sure they are clean and well rated. Most good hospitals and surgeons have a "Joint Center" and you have a private room, and great care. Choose the best surgeon you can find. Once you are recovered, probably within a month, you will wish you had it done sooner. No more pain.
Source: city-data.com

Medicare Supplemental Plans

One last note: It’s illegal for anyone to sell a second Medicare Supplement policy to a person when they know the person already has an existing policy. The only exception to this is if the insured notifies the insurance company, in writing, that they plan to cancel their existing Medicare Supplement policy. This web site offers you many useful tools for finding and comparing Medicare Supplement plans. You can also go to the main Medicare website (www.medicare.gov) and access the “Health and Drug Plans” search tool. Choose the “Compare Medigap Policies” tab and follow the instructions to view options in your area.
Source: medicare-providers.net

South Dakota Medicaid: The Medicaid Project, South Dakota Medicaid Eligibility,, Benefits

Posted by:  :  Category: Medicare

Many groups of people are covered by Medicaid. Even within these groups, though, certain requirements must be met. These may include your age, whether you are pregnant, disabled, blind, or aged; your income and resources (like bank accounts, real property, or other items that can be sold for cash); and whether you are a U.S. citizen or a lawfully admitted immigrant. The rules for counting your income and resources vary from state to state and from group to group. There are special rules for those who live in nursing homes and for disabled children living at home.
Source: quickbrochures.net

South Dakota hospital set to lose Medicare status

Pine Ridge isn’t the only IHS hospital that could lose Medicare funding. Rosebud (S.D.) Indian Health Service Hospital was set to lose its Medicare funding March 16, but CMS extended the termination date in early March. CMS granted an extension to explore a possible systems improvement agreement with the IHS.
Source: beckershospitalreview.com

South Dakota health insurance: find affordable coverage

Governor Daugaard’s proposal would have provided Medicaid to people currently in the coverage gap – everyone with incomes up to 100 percent of poverty level – but would have kept the current system of exchange subsidies for people with incomes between 100 percent and 138 percent of poverty level (about 22,000 people in South Dakota). Medicaid is less expensive for the federal government than exchange subsidies, but exchange subsidies don’t cost the states anything, while the states will eventually be on the hook for up to 10 percent of the total cost of Medicaid expansion.
Source: healthinsurance.org

South Dakota Department of Labor and Regulation

The mission of the Division of Insurance is to protect the public and make insurance available and affordable by efficiently providing quality assistance, providing fair regulation for industry, and promoting a healthy, competitive insurance market.
Source: sd.gov

South Dakota Department of Revenue(SD DOR)

Department of Revenue hosts taxpayer office hours in Huron – South Dakota Department of Revenue hosting auto dealer workshops – Watertown man sentenced for tobacco and sales tax fraud – Gaming Compact Hearing between State of South Dakota and Yankton Sioux Tribe – Special interest license plates available July 1 for qualifying vehicles – Transient Vendor Season in South Dakota – Summer 2016 DOR Newsletter – Municipal Tax Changes Effective July 1, 2016 – South Dakota sales tax increases on June 1 – 2016 DOR Legislative Session Recap – -More Press Releases
Source: sd.gov

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