NEBRASKA MEDICAID PROGRAM

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To apply for medical assistance, an application must be completed and given to the Nebraska Department of Health & Human Services. For more information, contact your nearest Department of Health and Human Services Office; Or, you may download an application form and mail it to the nearest Department of Health and Human Services Office.
Source: ne.gov

Nebraska DHHS: Division of Medicaid & Long Term Care

The State Unit on Aging collaborates with public and private service providers to ensure a comprehensive and coordinated community-based services system that will assist individuals to live in a setting they choose and continue to be contributing members of their community. Nebraska’s aging network includes eight Area Agencies on Aging.
Source: ne.gov

Nebraska Medicaid program

Currently, there are specific prior authorization (PA) forms for Proton Pump Inhibitors (PPIs), NSAIDs: CoxI, Single Entity or Combination Brand Name, and Low/Non-Sedating Antihistamines (LSAs) located at separate links on the website (nebraska.fhsc.com) on the tab, Prior Authorization, and the drop down for PA Forms. Beginning August 27, 2012, these drug class specific PA forms will be replaced by the Documentation of Medical Necessity form which currently exists at its own link under PA forms. When going to the link for these drug class specific forms, the Documentation of Medical Necessity form will be provided and should be used to request prior authorization. Additionally, the PDL Exception Request form will also be replaced by the Documentation of Medical Necessity form and will be provided at the link on the same website on the tab, Preferred Drug List, and the drop down for PDL Exception Request.
Source: fhsc.com

Nebraska Medicaid: The Medicaid Project, Nebraska Medicaid Eligibility, Programs, Requirements

“The Nebraska Medical Assistance Program, also known as the Medicaid Program, is a program that is jointly funded by the State and the Federal government to provide medical coverage to those who meet certain categorical eligibility criteria and who cannot afford to pay for medically necessary services. Covered services include inpatient and outpatient hospital services; nursing facility care; prescription drugs; services of physicians, dentists and other practitioners; screening and diagnostic services; home health services; mental health and substance abuse treatment; and medical supplies. ” *source:
Source: quickbrochures.net

What’s Medicare Supplement Insurance (Medigap)?

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Some Medigap policies also offer coverage for services that Original Medicare doesn’t cover, like medical care when you travel outside the U.S. If you have Original Medicare and you buy a Medigap policy, Medicare will pay its share of the Medicare-approved amount for covered health care costs. Then your Medigap policy pays its share.
Source: medicare.gov

Medicare: What Are Medigap Plans?

If you are going to buy a Medigap plan, the open enrollment period is six months from the first day of the month of your 65th birthday — as long as you are also signed up for Medicare Part B — or within six months of signing up for Medicare Part B. During this time, you can buy any Medigap policy at the same price a person in good health pays. If you try to buy a Medigap policy outside this window, there is no guarantee that you’ll be able to get coverage. If you do get covered, your rates might be higher.
Source: webmd.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

Medicare Supplement Plans

Some states may offer Medigap plan options to beneficiaries under 65 who qualify for Medicare because of disability or certain conditions (such as end-stage renal disease). Federal law doesn’t require states to sell Medicare Supplement insurance to beneficiaries under 65. However, depending on where you live, some states may offer Medigap coverage to beneficiaries under 65; eligibility and the specific available options may vary by state. If you’re a Medicare beneficiary under 65 and interested in purchasing Medicare Supplement insurance, contact your state insurance department to learn if you’re eligible for Medigap coverage in your state.
Source: ehealthinsurance.com

Medicare Supplement Insurance "Medigap"

Q: Who can explain these Medigap changes to me? A: Contact your insurance agent or the insurance company if you have questions about your Medigap policy and the new changes in Medigap Plans. You may also contact HICAP (Health Insurance Counseling and Advocacy Program) at 1-800-434-0222 for answers to many health insurance questions. For information about Medicare or Medigap call: 1-800-MEDICARE (1-800-633-4227) or visit the Official U.S. Government Site for People with Medicare.
Source: ca.gov

Competitive Bidding Program areas

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

DMEPOS Competitive Bidding

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

MEDICARE ANNOUNCES THE COMPETITIVE BIDDING AREAS AND PRODUCT CATEGORIES FOR THE SECOND ROUND OF THE

The Centers for Medicare & Medicaid Services (CMS) have announced the Metropolitan Statistical Areas (MSAs) and product categories for the second round of the Medicare durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) new competitive bidding program.  The program is designed to improve the effectiveness of Medicare’s DMEPOS payments, reduce beneficiary out-of-pocket costs, and save the Medicare program money while ensuring beneficiary access to quality DMEPOS items and services by requiring suppliers to be accredited by a Medicare-recognized accreditation organization.
Source: pedorthics.org

The competitive bidding demonstration

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

DMEPOS Competitive Bidding

Today President Obama signed into law H.R. 2, the “Medicare Access and CHIP Reauthorization Act of 2015″ (MACRA), which reforms Medicare payment policy for physician services and adopts a series of policy changes affecting a wide range of providers and suppliers. Most notably, MACRA permanently repeals the statutory Sustainable Growth Rate (SGR) formula, achieving a goal that has eluded Congress for years. Now, after a period of stable payment updates, MACRA will link physician payment updates to quality, value measurements, and participation in alternative payment models.… Continue Reading
Source: healthindustrywashingtonwatch.com

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

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

The Medicare Part D Prescription Drug Benefit

The Medicare Modernization Act of 2003 (MMA) established a voluntary outpatient prescription drug benefit for people on Medicare known as Part D, which went into effect in 2006. All 55 million people on Medicare, including those ages 65 and older and those under age 65 with permanent disabilities, have access to the Medicare drug benefit through private plans approved by the federal government. During the Medicare Part D open enrollment period, which runs from October 15 to December 7 each year, beneficiaries can choose to enroll in either stand-alone prescription drug plans (PDPs) to supplement traditional Medicare or Medicare Advantage prescription drug (MA-PD) plans (mainly HMOs and PPOs) that cover all Medicare benefits including drugs. Beneficiaries with low incomes and modest assets are eligible for assistance with Part D plan premiums and cost sharing. This fact sheet provides an overview of the Medicare Part D program and information about 2016 plan offerings, based on data from the Centers for Medicare & Medicaid Services (CMS) and other sources.
Source: kff.org

The Role of Medicare and the Indian Health Service for American Indians and Alaska Natives: Health, Access and Coverage

Elderly American Indians and Alaska Natives report having health problems at higher rates than the overall U.S. population age 65 and older.  Turning to other surveys that focus on health issues, 39 percent of American Indians and Alaska Natives age 65 and over describe their overall health status as “fair” or “poor,” compared with a little more than 26 percent in the overall population age 65 and older (Figure 2).  Further, elderly American Indians and Alaska Natives are hospitalized during the year at twice the rate of the overall population age 65 and older (33% vs. 16%), consistent with having higher rates of certain health problems (Figure 3).  For example, nearly a third of American Indians and Alaska Natives age 65 and over report having diabetes, compared with 22 percent in the overall 65+ population.  While the prevalence of coronary heart disease is comparable between these groups, the share of elderly American Indians and Alaska Natives with a previously diagnosed stroke or heart attack is higher compared with the overall population age 65 and older.  Elderly American Indians and Alaska Natives also report more frequently that they suffered depression at some point in their lives, consistent with other research showing higher rates of mental illness among non-elderly American Indians and Alaska Natives.
Source: kff.org

Highmark: Your Health Care Partner

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Highmark Inc. is a national, diversified health care partner serving members through its businesses in health insurance, dental insurance, vision care and reinsurance. Our mission is to make high-quality health care readily available, easily understandable and truly affordable in the communities we serve.
Source: highmark.com

Highmark Direct :: Medicare Information

Highmark is a registered mark of Highmark Inc. Highmark Choice Company, Highmark Senior Health Company and Highmark Senior Solutions Company are Medicare Advantage plans with a Medicare contract. HM Health Insurance Company is a PDP plan with a Medicare contract. Enrollment in Highmark Choice Company, Highmark Senior Health Company, Highmark Senior Solutions Company and HM Health Insurance Company depends on contract renewal. Highmark Senior Health Company, Highmark Choice Company, Highmark Senior Solutions Company and HM Health Insurance Company are independent licensees of the Blue Cross and Blue Shield Association.
Source: highmarkdirect.com

Highmark Medicare Services Inc Becomes Novitas Solutions Inc

Effective March 10, Novitas Solutions will begin to migrate the current HMS Web site to the new Novitas Solutions Web site, www.novitas-solutions.com. Novitas is targeting completing the name change to all active Web page content by March 30. Although main headers throughout the Web site will be changed, some historical documents, such as Medicare reports issued under HMS, will not be changed to reflect the new name.
Source: apta.org

​UPMC’s Medicare Advantage Provider Contracts with Highmark Will Not Be Extended for 2016

Nearly a year ago, however, Highmark stopped paying UPMC the rates specified in those contracts for that world-class care—including treatment for cancer at the renowned Hillman Cancer Center—and claimed that it has the right to reduce rates whenever and however it wishes. Although UPMC gave Highmark more than sufficient opportunity to take the required corrective actions, it has refused. As a result of Highmark’s breach of its UPMC contracts, and in keeping with UPMC’s right to end the contracts at the end of each calendar year with or without cause, UPMC has provided Highmark with notices of non-renewal of the current Medicare Advantage contracts effective January 1, 2016. No responsible organization could enter into—let alone extend—such illusory and one-sided contracts.
Source: upmc.com

Highmark Direct Health Insurance Stores :: Home

The Blue Cross Store of Northeastern Pennsylvania is now Highmark Direct. You’ll still have access to the same great doctors you expect from a partner you trust to cover your health. Visit our retail locations in Williamsport, Dickson City and Bartonsville.
Source: highmarkdirect.com

Dental Insurance & Dental Plans

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A dental savings plan functions a lot like a membership at a warehouse club. You pay an annual fee and get access to significantly reduced rates. And dental savings plans offer many benefits over traditional dental insurance. Things like no annual caps or limits and absolutely no paperwork.
Source: dentalplans.com

How Medicare Advantage Plans work

Posted by:  :  Category: Medicare

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

What is a Medicare Advantage Plan?

If you have health coverage from your union or current or former employer when you become eligible for Medicare, you may automatically be enrolled in a Medicare Advantage Plan that they sponsor. You have the choice to stay with this plan, switch to Original Medicare, or enroll in a different Medicare Advantage Plan. Be aware that if you switch to Original Medicare or enroll in a different Medicare Advantage Plan, your employer or union could terminate or reduce your health benefits, the health benefits of your dependents, and any other benefits you get from your company. Talk to your employer/union and your plan before making changes to find out how your health benefits and other benefits may be affected.
Source: medicareinteractive.org

Compare Medicare Advantage & Supplemental Plans

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

Health and Human Services Commission

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Eligible Texas women on Medicaid can go straight to their pharmacist to pick up mosquito repellent, Health and Human Services Executive Commissioner Charles Smith announced today. Texas Medicaid has issued a standing order for mosquito repellent prescriptions for women who are between the ages of 10 and 45 or pregnant. Ver comunicado de prensa en español
Source: tx.us

Welcome to Your Texas Benefits

You can fill out this screening form to find out which benefits and support services you might be able to get. At the end of the form, you can decide if you want to log in and: (1) apply for benefits, and (2) send your form to support programs and ask them to contact you about their services.
Source: yourtexasbenefits.com

Dean Clinic, Dean Health Plan, Dean Foundation

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Online Member Guide Premium Payments Member Benefits Document Center Pharmacy Services & Programs State Employee Members Medicare Members BadgerCare Plus Members Living Healthy Program All Member Resources
Source: deancare.com

What Is a Health Insurance Premium?

Posted by:  :  Category: Medicare

Once a patient’s deductibles, copayments, and coinsurance paid for a particular year add up to the out-of-pocket maximum, the patient’s cost-sharing requirements are then finished for that particular year. Following the fulfillment of the out-of-pocket maximum, the health plan then picks up all of the cost of covered in-network care for the remainder of the year.
Source: verywell.com

How Health Insurance Marketplace Plans Set Your Premiums

Plan category: There are five plan categories – Bronze, Silver, Gold, Platinum, and catastrophic. The categories are based on how you and the plan share costs. Bronze plans usually have lower monthly premiums and higher out-of-pocket costs when you get care. Platinum plans usually have the highest premiums and lowest out-of-pocket costs.
Source: healthcare.gov

Analysis of 2015 Premium Changes in the Affordable Care Act’s Health Insurance Marketplaces

The map and 50-state table are updates to our September analysis, which examined premium changes for the lowest-cost bronze plan and the two lowest-cost silver plans in 16 major cities. The second-lowest cost silver plan in each state is of particular interest as it acts as a benchmark that helps determine how much assistance eligible individuals can receive in the form of federal tax credits. Although premium changes vary substantially across and within states, premium changes for 2015 in general are modest when looking at the low-cost insurers in the marketplaces, where enrollment is concentrated.
Source: kff.org

What Is a Health Insurance Premium?

A number of factors impact the premiums you pay for health insurance. For instance, employer groups typically obtain lower prices relative to what individuals get on their own. The insurance company provides that discount because there is an advantage in acquiring a 500- or 1,000-employee customer base as opposed to an individual customer. In general, rising single and group policy rates were a major factor in the introduction of the Affordable Care Act. As of January 2015, average family premiums were $16,800 per year.
Source: ehow.com