Medicare Advantage Cuts in the Affordable Care Act: April 2014 Update

Posted by:  :  Category: Medicare

The overwhelming majority of Medicare Advantage enrollees will face significant benefit cuts in 2015, relative to benefit levels in 2014. This is primarily the result of ACA-mandated changes to the benchmark payment formula, and the elimination of the star rating bonus pilot program. The cuts are somewhat mitigated by changes in risk adjustment and other factors. Compared to the pre-ACA baseline, all beneficiaries are experiencing a substantial benefit reduction. The overwhelming majority of this reduction is due to ACA-mandated changes to the benchmark formulas in effect in 2010 and prior years. The effect of the star rating pilot program is absent, since star ratings were not used to determine payments at all prior to 2012. The effect of year-to-year (and even cumulative) adjustment factors is small compared to the cumulative effects of the benchmark changes mandated by the ACA.
Source: americanactionforum.org

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

The Success of Medicare Advantage Plans: What Seniors Should Know

Government payments should encourage beneficiary savings. Ideally, beneficiaries should be able to secure the full savings of any choices that they make, which means that they would be able to pocket 100 percent of the dif­ference between the government contribution and the price of a lower-cost health plan. Under Medicare Advantage, the beneficiaries can secure only 75 percent of the savings from choosing a plan that offers a product at a price below the Medicare benchmark. Under the FEHBP formula, the government contribution for federal employees and retirees is limited to 75 percent of the premium cost of any compet­ing health plan, upto the capped amount. Incidentally, the FEHBP’s own payment for­mula could be improved. If the government contribution in that program were permitted to reach 100 percent of the capped amount, it would encourage federal employees to choose less expensive plans, gaining savings for them­selves as well as for taxpayers. Such an arrangement should be provided to future Medicare beneficiaries in any new premium support system.
Source: heritage.org

Coventry Medicare: First Health Part D

Posted by:  :  Category: Medicare

First Health Part D (Legal Disclaimers) 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 service area. ©2016 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 co-payments/co-insurance 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 1 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

2015 in AR Plan Benefits Explained

AK AL AR AS AZ CA CO CT DC DE FL GA GU HI IA ID IL IN IS KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR RI SC SD TN TX UT VA VI VT WA WI WV WY
Source: q1medicare.com

Medicare Part D Plans, Prescription Drug Plan (PDP)

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 service area. ©2016 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 1 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

Coventry Medicare: First Health Part D

First Health Part D (Legal Disclaimers) 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 service area. ©2016 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 co-payments/co-insurance 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 1 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: firsthealthpartd.com

First Health Network: Members

At First Health, we are always looking for ways to provide you with the information you need to make wise choices about your health care.  The most convenient method to find a doctor, hospital or other health care service provider in the First Health Network is by searching our provider search via this website.  The provider search includes the most detailed provider information available and is updated regularly.  Access to our provider search online is available 24/7, 365 days a year. Or you may contact us and speak with a representative who can assist you in locating a provider. 
Source: coventryhealthcare.com

Express Scripts Members: Start Home Delivery, Order Refills, Order Prescriptions

The security of your personal information is important. At Express Scripts, we protect the sensitive information in our care with the industry’s most current technologies. Some older web browsers no longer meet our security requirements. Starting December 18th, you will not be able to use Internet Explorer version 6 or earlier to access our website. Please upgrade to Internet Explorer version 7 or later, or to another current web browser.
Source: express-scripts.com

Am I eligible for Medicare if I am under 65?

Posted by:  :  Category: Medicare

Note that Social Security, not Medicare, makes the determination of whether you qualify for SSDI checks. In addition, the Social Security Disability Insurance program administers these checks as long as you or your family members have worked long enough and paid Social Security taxes. For more information on the Social Security Disability Insurance program, it’s best to contact your local Social Security Administration office.
Source: medicareinteractive.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 Supplemental Insurance

When you buy insurance, any insurance, its purpose is to cover you for unexpected costs you could never cover yourself. You buy homeowners insurance to cover damage done by a fire or a storm or water damage done by a broken pipe. No one buys a homeowner’s policy that covers utilities or routine maintenance. Most people who own a house are used to paying for the cost of painting it. Homeowners expect to pay for the cost of replacing their roof every 20 years as well, even though the cost of a new roof on most houses would actually exceed the cost a Medicare patient would pay for the treatment for most cancers.
Source: truecostofhealthcare.net

Find and Compare Best Medicare Plans Online

The Original Medicare Plan, or Part A and Part B coverage, is a federally managed fee-for-service plan. Beneficiaries can choose the doctor and hospital from which they would like to receive services. Monthly premiums, annual deductibles and co-payments for services are required. Prescription drug coverage, or Medicare Part D, may be added to the Original Medicare Plan. Many beneficiaries covered by the Original Medicare Plan find they also need the Medigap policy to help pay for services not covered by Part A and Part B. Medicare Advantage Plans (Part C) provides Part A and Part B coverage, but this coverage is provided by private insurance companies that have been approved by Medicare. Because private companies provide this coverage, additional benefits may be available. Additionally, the amounts charged for various services may differ between providers. Part C plans may have networks, and the beneficiary will have to utilize the services of providers in the plan’s network. Prescription drug coverage is often included in this plan. Beneficiaries of Medicare Part C do not need to purchase Medigap coverage. When choosing a plan it is important to determine what is expected from the insurance coverage. It would be advantageous for beneficiaries to compare and select coverage based on the plan that will best meet their individual needs.
Source: online-health-insurance.com

Medicare Supplemental Health Insurance Plans

"The shopping and purchase of my insurance policy went smooth.  Jim Corn had a lot of patience and thoroughly answered all my questions. I worked exclusively with him over the phone.  He set times for us to discuss my choices and he called at the designated time without fail.  He’s never late.  I didn’t find myself frustrated at the entire process simply because Jim walked me through the different plans and explained them in detail."
Source: medigapadvisors.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

Medicare Plans for Different Needs

Posted by:  :  Category: Medicare

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

A list of 161 hospitals or hospital groups, ranked by the five-year change in readmissions penalties, 2013-17. Institutions are all members of America’s Essential Hospitals. Readmissions penalties are assigned by CMS Certification Number, so in hospital groups that share a single number, only the…
Source: modernhealthcare.com

Medicare Hospital Compare Quality of Care

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

Costs for Medicare drug coverage

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

How much does Medicare Part D cost?

Part D premiums range from $10-$100 per month (depending on the plans available in your area and on the partiular plan you choose). The maximum deductible — the amount you must pay out-of-pocket before Medicare will contribute to your prescription costs — in 2016 is $360. After you meet the deductible, Medicare will pay roughly 75% of your prescription costs.
Source: nolo.com

Medicare Part D Costs & Coverage

After you reach your yearly deductible, you may still be responsible for certain out-of-pocket costs, even after your Medicare plan has covered its share. This may include coinsurance and copayments. If you have to pay a coinsurance, you will be responsible for a percentage of the cost of the drug. For example, you may owe a 15% coinsurance each time you fill a particular prescription. If you have to pay a copayment, you will be responsible for paying a set amount for medications on a certain tier as determined by your Medicare plan. As mentioned, Medicare plans that cover prescription drugs place covered drugs into cost tiers, and medications on higher tiers may have higher copayments and coinsurance costs. Your cost sharing may also vary depending on whether you’re taking brand-name or generic medications; generics tend to have lower costs than brand-name prescription drugs.
Source: ehealthinsurance.com

Extra Help with Medicare Prescription Drug Plan Costs

Medicare beneficiaries can qualify for Extra Help with their Medicare prescription drug plan costs. The Extra Help is estimated to be worth about $4,000 per year. To qualify for the Extra Help, a person must be receiving Medicare, have limited resources and income, and reside in one of the 50 States or the District of Columbia.
Source: ssa.gov

The United States Social Security Administration

Posted by:  :  Category: Medicare

Every year, millions of Americans become victims of identity theft. Identity theft occurs when someone steals your personally identifiable information and pretends to be you. They can use this information to open bank or credit card accounts…
Source: ssa.gov

New or Replacement Social Security Number and Card

You need a Social Security number to get a job, collect Social Security benefits and get some other government services. But you don’t often need to show your Social Security card. Do not carry your card with you. Keep it in a safe place with your other important papers.
Source: ssa.gov

Social Media Marketing, Statistics & Monitoring Tools

Socialbakers Analytics equips us with the KPIs and metrics we need to meaningfully evaluate our performance across social channels and countries, generating valuable feedback and local intelligence so we can focus on continuous improvement in our markets.
Source: socialbakers.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

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

Medicare Hospital Compare Quality of Care

The page could not be loaded. The Medicare.gov Home page currently does not fully support browsers with "JavaScript" disabled. Please note that if you choose to continue without enabling "JavaScript" certain functionalities on this website may not be available.
Source: medicare.gov

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

Posted by:  :  Category: Medicare

The page could not be loaded. The Medicare.gov Home page currently does not fully support browsers with "JavaScript" disabled. Please note that if you choose to continue without enabling "JavaScript" certain functionalities on this website may not be available.
Source: medicare.gov

Medicare Hospital Compare Quality of Care

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

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

Extra Help with Medicare Prescription Drug Plan Costs

Medicare beneficiaries can qualify for Extra Help with their Medicare prescription drug plan costs. The Extra Help is estimated to be worth about $4,000 per year. To qualify for the Extra Help, a person must be receiving Medicare, have limited resources and income, and reside in one of the 50 States or the District of Columbia.
Source: ssa.gov

Medicare Advantage Drug Formulary

Posted by:  :  Category: Medicare

Generally, if you are taking a drug that was covered at the beginning of the year, we will not discontinue or reduce coverage of the drug during the coverage year except when we receive information from the FDA that a drug is no longer safe or effective. Complete information about these changes is included in the formulary documents above. Group Health Medicare Advantage plans cover both brand name drugs and generic drugs. Generic drugs have the same active-ingredient formula as a brand name drug. Generic drugs usually cost less than brand name drugs and are rated by the Food and Drug Administration (FDA) to be as safe and effective as brand name drugs.
Source: ghc.org

Medicare Part D Formulary, List of PDP Drugs

Medicare Part B covered drugs include a limited number of prescription drugs such as those you get in a hospital outpatient department under certain circumstances, injected drugs you get in a doctor’s office, certain oral cancer drugs, and drugs used with some types of durable medical equipment (like a nebulizer or infusion pump). Certain diabetic supplies, such as: monitors, test strips and lancets are covered under Part B.  Medicare Part B drugs include, but are not limited to, the following types of drugs:
Source: coventryhealthcare.com

Medicare Advantage Formulary Search

The formulary may change during the year. If we make any formulary change that impacts our members’ abilities to fill their prescriptions, we will notify those members prior to the change being made. If you have questions or would like additional plan information about our network pharmacies in your area, please call us at (844) 550-6886 (HMO); (844) 550-6896 (PPO), 8 a.m. to 8 p.m. CST, seven days a week. TTY/TDD users can call 711.
Source: memorialhermann.org

Coventry Medicare: Formulary (Drug List)

A formulary is a list of prescription medications that are covered by your plan and are available in a booklet format and an online searchable tool.       A pharmacy directory is a listing of pharmacies in your plan’s network, including preferred retail pharmacies, mail-order, home infusion and long-term care pharmacies.    
Source: coventryhealthcare.com

2016 Medicare Advantage plan formulary and drug coverage

That’s one question most people have when choosing a Medicare Advantage plan. The Priority Health Medicare 2016 Formulary tells you what prescription drugs are covered. The formulary also includes each drug’s “tier,” or cost level.
Source: priorityhealth.com