How to compare Medigap policies

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

Nevada Medicare Supplemental Insurance

The federal government has established 10 plans for Medigap policies: A, B, C, D, F, G, K ,L M ,and N. Plan F is the most comprehensive plan, and it is the most popular in Nevada and through the entire United States. Regardless of which insurance company sells you a policy or how much you pay for it, a plan with any given letter is identical to the same plan sold by another insurance company. To find out which plan will best fit your personal health care needs, fill out the zip code form to compare plans instantly, or, visit our Medigap Plans Page to learn more about what each specific plan offers.
Source: medicaresupplementalinsurance.com

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 (Medicare Supplement Health Insurance)

A Medigap policy is health insurance sold by private insurance companies to fill the “gaps” in Original Medicare Plan coverage. Medigap policies help pay some of the health care costs that the Original Medicare Plan doesn’t cover. If you are in the Original Medicare Plan and have a Medigap policy, then Medicare and your Medigap policy will each pay its share of covered health care costs. Generally, when you buy a Medigap policy you must have Medicare Part A and Part B. You will have to pay the monthly Medicare Part B premium ($96.40 in 2011 for most beneficiaries). In addition, you will have to pay a premium to the Medigap insurance company. As long as you pay your premium, your Medigap policy is guaranteed renewable. This means it is automatically renewed each year. Your coverage will continue year after year as long as you pay your premium. In some states, insurance companies may refuse to renew a Medigap policy bought before 1992. Insurance companies can only sell you a “standardized” Medigap policy. Medigap policies must follow Federal and state laws. These laws protect you. The front of a Medigap policy must clearly identify it as “Medicare Supplement Insurance.” It’s important to compare Medigap policies, because costs can vary. The standardized Medigap policies that insurance companies offer must provide the same benefits. Generally, the only difference between Medigap policies sold by different insurance companies is the cost. You and your spouse must buy separate Medigap policies.Your Medigap policy won’t cover any health care costs for your spouse. Some Medigap policies also cover other extra benefits that aren’t covered by Medicare. You are guaranteed the right to buy a Medigap policy under certain circumstances. For more information on Medigap policies, you may call 1-800-633-4227 and ask for a free copy of the publication “Choosing a Medigap Policy: A Guide to Health Insurance for People With Medicare.” You may also call your State Health Insurance Assistance Program (SHIP) and your State Insurance Department. Phone numbers for these Departments and Programs in each State can be found in that publication.
Source: cms.gov

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

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

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

Medicare claims processing manual

Posted by:  :  Category: Medicare

27. 20.1.2 – Outliers (Rev. 2111, Issued: 12-03-10, Effective: 04-01-11, Implementation: 04-04-11) §1886(d)(5)(A) of the Act provides for Medicare payments to Medicare-participating hospitals in addition to the basic prospective payments for cases incurring extraordinarily high costs. This additional payment known as an “Outlier” is designed to protect the hospital from large financial losses due to unusually expensive cases. To qualify for outlier payments, a case must have costs above a fixed-loss cost threshold amount (a dollar amount by which the costs of a case must exceed payments in order to qualify for outliers), which is published in the annual Inpatient Prospective Payment System final rule. The regulations governing payments for operating costs under the IPPS are located in 42 CFR Part 412. The specific regulations governing payments for outlier cases are located at 42 CFR 412.80 through 412.86. The actual determination of whether a case qualifies for outlier payments is made by the Medicare contractor using Pricer, which takes into account both operating and capital costs and Medicare severity-diagnostic related group (MS-DRG) payments. That is, the combined operating and capital costs of a case must exceed the fixed loss outlier threshold to qualify for an outlier payment. The operating and capital costs are computed separately by multiplying the total covered charges by the operating and capital cost-to-charge ratios. The estimated operating and capital costs are compared with the fixed-loss threshold after dividing that threshold into an operating portion and a capital portion (by first summing the operating and capital ratios and then determining the proportion of that total comprised by the operating and capital ratios and applying these percentages to the fixed-loss threshold). The thresholds are also adjusted by the area wage index (and capital geographic adjustment factor) before being compared to the operating and capital costs of the case. Finally, the outlier payment is based on a marginal cost factor equal to 80 percent of the combined operating and capital costs in excess of the fixed-loss threshold (90 percent for burn MS-DRGs). Any outlier payment due is added to the MS-DRG adjusted base payment rate, plus any DSH, IME and new technology add-on payment. For a more detailed explanation on the calculation of outlier payments, visit our Web site at http://www.cms.hhs.gov/providers/hipps/ippsotlr.asp. The Medicare contractor may choose to review outliers if data analysis deems it a priority. The IPPS outliers are not applicable to non-PPS hospitals. The Pricer program makes all outlier determinations except for the medical review determination. Outlier payments apply only to the Federal portion of a capital PPS payment. 20.1.2.1 – Cost to Charge Ratios (Rev. 2111, Issued: 12-03-10, Effective: 04-01-11, Implementation: 04-04-11) For discharges before August 8, 2003, Medicare contractors used the latest final settled cost report to determine a hospital’s cost-to-charge ratios (CCRs). For those hospitals that met the criteria in part I. A. of PM A-03-058 (July 3, 2003), effective for discharges occurring on or after August 8, 2003 Medicare contractors are to use alternative CCRs
Source: slideshare.net

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

How to compare Medigap policies

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

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

Compare Medicare Supplement Plans Side by Side

Last but not least is the coverage you desire from your Medigap plan.  There are ten plans to choose from that are labeled Plan A – Plan N (plans E, H, I, and J are no longer offered).  Plan F is the most popular Medicare Supplement, because it offers the most comprehensive coverage on the market.  Plan G is a great plan because it also has extensive coverage, with lower premiums and rate increases than Plan F.  Another popular plan is Plan N, which has more cost sharing but lower premiums than the other Medigap policies. 
Source: medicareinsurancefinders.com

Compare Medicare Supplement Plans

Skilled Nursing Facility Care Coinsurance: This is a facility that handles the required daily involvement of skilled nursing or rehabilitation staff. Examples of skilled nursing facility care include intravenous injections and physical therapy. Medicare pays all of the first 20 days, all but $152 per day of the 21st through the 100th day of approved costs. Medicare pays nothing after the 100th day.  The plans pay all, some or none of the first 100 days deductibles or copays as indicated on the Comparison Chart.
Source: clearmedicaresolutions.com

Compare Mutual of Omaha Medicare Supplement insurance plans

Complete coverage for individuals ages 65 and over from Mutual of Omaha. We help cover healthcare cost that traditional Medicare does not. Allow our licensed health insurance agents find the right Plan for you. Get your FREE quote now!
Source: mutualofomahamedicareplans.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

Boomer Benefits Medicare Supplements

Our caring agents provide lifetime claims service for your Medicare insurance policy. This means when claims occur, you are not alone. You will have our experts on hand to help you sort through your statements, and even assist with appeals if necessary.
Source: boomerbenefits.com

Understanding the Medicare Part D Donut Hole

Posted by:  :  Category: Medicare

Once you and your Part D drug plan have spent $2,840 for covered drugs, you will be in the donut hole. Previously, you had to pay the full cost of your prescription drugs while in the donut hole. However, in 2011, you get a 50% discount on covered brand-name prescription medications. The donut hole continues until your total out-of-pocket cost reaches $4,550. This annual out-of-pocket spending amount includes your yearly deductible, copayment, and coinsurance amounts.
Source: verywell.com

Medicare Part D Donut Hole – Prescription Drug Coverage Gap

Most Medicare Part D Prescription Drug Plans have a coverage gap, sometimes called the Medicare “donut hole.” This means that after you and your Medicare drug plan have spent a certain amount of money for covered prescription drugs, you then have to pay all costs out-of-pocket for the drugs, up to a certain out-of-pocket limit. The yearly deductible, coinsurance, or copayments, and what you pay while in the coverage gap, all count toward this out-of-pocket limit. The limit doesn’t include the drug plan’s premium.
Source: ehealthmedicare.com

Medicare Part D coverage gap

The Medicare Part D coverage gap (informally known as the Medicare donut hole) is a period of consumer payment for prescription medication costs which lies between the initial coverage limit and the catastrophic-coverage threshold, when the consumer is a member of a Medicare Part D prescription-drug program administered by the United States federal government. The gap is reached after shared insurer payment – consumer payment for all covered prescription drugs reaches a government-set amount, and is left only after the consumer has paid full, unshared costs of an additional amount for the same prescriptions. Upon entering the gap, the prescription payments to date are re-set to $0 and continue until the maximum amount of the gap is reached: copayments made by the consumer up to the point of entering the gap are specifically not counted toward payment of the costs accruing while in the gap.
Source: wikipedia.org

Closing the Medicare Part D Donut Hole

The Affordable Care Act (ACA) includes important improvements to Medicare prescription drug coverage (Part D) such as reducing expenses for seniors in the donut hole now and eliminating the gap altogether by 2020. Seniors receive additional savings each year on their prescription drugs until the donut hole is closed. The ACA also provides additional assistance for low-income beneficiaries. Since passage of the ACA in 2010, more than 9.4 million people with Medicare have saved over $15 billion on prescription drugs.  
Source: ncpssm.org

Medicare Part D Donut Hole

It’s important to continue to stick with your prescription drug plan and pharmacy once you hit the coverage gap. If you have a Medicare prescription drug plan that already includes coverage in the gap, you may get a discount after your plan’s coverage has been applied to the price of the drug. The discount for brand-name drugs will apply to the remaining amount that you owe.
Source: walgreens.com

Medicare Part D Coverage Gap

Coverage gap, also known as the “donut hole”: While in the coverage gap, you’ll pay 45% of the plan’s cost for brand-name drugs and 58% of the plan’s cost for generic drugs in 2016. You’re out of the coverage gap once your yearly out-of-pocket drug costs reach $4,850 in 2016. Once you have spent this amount, you’ve entered the catastrophic coverage phase. The costs paid by you or someone on your behalf (such as a spouse or loved one) for Part D drugs on your plan’s formulary will count toward your out-of-pocket costs. Additionally, manufacturer discounts for brand-name drugs count towards reaching the spending limit that begins catastrophic coverage. If your plan requires you to get your drugs from a participating pharmacy, make sure you do so, or else the costs may not apply. Keep in mind that costs that are paid for you by other insurance you may have, such as prescription drug coverage through an employer, won’t count towards your out-of-pocket spending.
Source: medicare.com

Health Insurance Fact Sheets

Posted by:  :  Category: Medicare

Note: Dates on the Department’s consumer fact sheets indicate the date of creation or last revision. In a fast-changing insurance marketplace, the Department continually evaluates these fact sheets to ensure that the information provided is helpful, accurate, and up-to-date.
Source: illinois.gov

Get Health Insurance Answers from Healthcare.gov Marketplace

If you enrolled in a Marketplace plan for 2016 and your income or household change, you should report the changes as soon as possible. These changes – like higher or lower income, adding or losing household members, or getting offers of other health coverage – may affect the coverage or savings you’re eligible for.
Source: healthcare.gov

Financial Security of Elderly Americans at Risk: Proposed changes to Social Security and Medicare could make a majority of seniors ‘economically vulnerable’

Posted by:  :  Category: Medicare

To better measure the economic vulnerability of older adults, they suggest using the Elder Economic Security Standard Index (Elder Index) developed by Wider Opportunities for Women (WOW). The Elder Index estimates how much it costs seniors to live in different communities across the country, accounting for an elder household’s housing type, transportation type, health status, and geography-specific cost of living. The index is more comprehensive than the SPM in its appraisal of costs, including food, housing, healthcare, and transportation costs, as well as miscellaneous expenses such as telephone, clothing, and personal care costs and relevant sales taxes. At the time we began our analysis, the measure had only been produced for 17 states, and therefore could not be used to assess elderly vulnerability nationwide. However, when we compared the index’s state-level thresholds to SPM thresholds for those same areas, we found a measurable pattern: The Elder Economic Security Standard Index threshold (the line below which the elderly are considered economically insecure) is roughly 200 percent of, or twice, the SPM threshold, on average. (Note that WOW has since released Elder Index values for states, counties, and cities throughout the United States; the data are available at www.basiceconomicsecurity.org/EI)
Source: epi.org

National and Regional Trends in Heart Failure Hospitalization and Mortality Rates for Medicare Beneficiaries, 1998

a phenomenon that makes the observed decline in HF hospitalization rates in the fee-for-service population even more dramatic, considering the latter group would be expected to be composed of sicker patients. Although the decline in risk-adjusted 1-year mortality rate of an absolute 2.1 percentage points between 1999 and 2008 was statistically significant, we must be cautious in its interpretation. First, risk-adjusted 1-year mortality appeared to have a nadir in 2006, and thus more recent mortality trends may not be as favorable. In addition, we note that the absolute number of lives saved over time was modest. If the 2008 Medicare fee-for-service HF population had the 1-year mortality rate of 1998, this represents only an additional 8378 HF patients alive at 1 year. Although any improvements in HF survival are to be welcomed, reductions in 1-year mortality over the past decade were modest on an absolute scale. Lastly, not all states had equal decreases in 1-year mortality; in fact, 5 states had significant increases in 1-year mortality over the study period, indicating a need for better treatment strategies in these areas.
Source: jamanetwork.com

2011 Neurology CPT Code Changes

Count every hour of physician attendance: 95961 and 95962. Report 95961 for the first hour of physician attendance. Use modifier 52 with 95961 for 30 minutes or less. Report 95962 for each additional hour of physician attendance.
Source: klahealthcare.com

Medicare coverage of outpatient mental health services

Posted by:  :  Category: Medicare

of Medicare. Be sure to ask any provider if they take Medicare before you begin receiving services. Remember, if you see an opt-out provider, they must have you sign a private contract. The contract states that your doctor does not take Medicare and you must pay the full cost of the service yourself. Medicare will not reimburse you if you see an opt-out provider. If your provider does not have you sign a contract, you are not responsible for the cost of care.
Source: medicareinteractive.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

Learn What to do If you Already Have Medicare Health Coverage

Yes. Coverage from an employer through the SHOP Marketplace is treated the same as coverage from any job-based health plan. If you’re getting health coverage from an employer through the SHOP Marketplace based on your or your spouse’s current job, Medicare Secondary Payer rules apply.
Source: healthcare.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

Mental health care (outpatient)

Part B covers outpatient mental health services, including services that are usually provided outside a hospital (like in a clinic, doctor’s office, or therapist’s office) and services provided in a hospital’s outpatient department. Part B also covers outpatient mental health services for treatment of inappropriate alcohol and drug use. Part B helps pay for these covered outpatient services:
Source: medicare.gov

Medicare Coverage of Home Health Care

If you are interested in home health care after a stay in the hospital, or as an alternative to a stay in a hospital or nursing facility, contact a home health care agency recommended by your doctor or the hospital discharge planner. The discharge planner can even contact an agency for you. You may also get help in locating home health care agencies from a community health organization, visiting nurses association, United Way, Red Cross, or neighborhood senior center. Medicare.gov lists home health care agencies in your area and allows you to compare the quality of their service depending on past performance.
Source: nolo.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 Information, Help, and Plan Enrollment

Humana is a Medicare Advantage HMO, PPO and PFFS organization and a stand-alone prescription drug plan with a Medicare contract. Enrollment in any Humana plan depends on contract renewal. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments and restrictions may apply. Plan Formulary may change at any time. You will receive notice when necessary. Benefits, premiums, and/or co-payments and/ or co-insurance may change on January 1 of each year.
Source: medicare.com

2013 Medicare Tax Rate is 1.45%, Additional Medicare Tax Rate is 0.9%

Posted by:  :  Category: Medicare

In addition to withholding Medicare tax at 1.45%, employers must withhold a 0.9% Additional Medicare Tax from wages paid to an employee in excess of $200,000 in a calendar year. Employers are required to begin withholding Additional Medicare Tax in the pay period in which wages in excess of $200,000 are paid to an employee and continue to withhold it each pay period until the end of the calendar year. Additional Medicare Tax is only imposed on the employee. There is no employer share of Additional Medicare Tax. All wages that are subject to Medicare tax are subject to Additional Medicare Tax withholding if paid in excess of the $200,000 withholding threshold.
Source: prweb.com

What is Medicare Tax? definition and meaning

Tax deducted from the wages of every legally working American that is used to pay for the Medicare program provided to individuals over the age of 65. This is typically another line item included on an employee’s paystub. At the end of year, the employer will provide the employee with a W-2 and this will include the total amount deducted from the individual’s paycheck for the Medicare tax. The tax was implemented under the Federal Insurance Contributions Act.
Source: investorwords.com

Be Prepared for Higher Medicare Premiums

Everything that goes into AGI will impact their Medicare premiums. This includes extraordinary capital gains, distributions from IRAs and qualified retirement plans (but not Roth distributions) and bonuses from work, in addition to salary and other regular income. It may not seem fair, but a one-­time jump in income from the sale of a business or other asset will trigger the IRMAA, with no grounds for appeal unless the client experienced one of the specific life-­changing events shown on Form SSA­44: marriage, divorce, death of a spouse, work stoppage, work reduction, loss of income-­producing property, loss of pension payment, or receipt of an employer settlement payment.
Source: coastal.tax

Medicare Sustainable Growth Rate

Section 101 of the Tax Relief and Health Care Act of 2006 (MIEA-TRHCA) provided a 1-year update of 0% for the conversion factor for CY 2007 and specified that the conversion factor for CY 2008 must be computed as if the 1-year update had never applied. Section 101 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA) provided a 6-month increase of 0.5% in the CY 2008 conversion factor, from January 1, 2008, through June 30, 2008, and specified that the conversion factor for the remaining portion of 2008 and the conversion factors for CY 2009 and subsequent years must be computed as if the 6-month increase had never applied. Section 131 of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) extended the increase in the CY 2008 conversion factor that was applicable for the first half of the year to the entire year, provided for a 1.1% increase to the CY 2009 conversion factor, and specified that the conversion factors for CY 2010 and subsequent years must be computed as if the increases had never applied.
Source: wikipedia.org