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

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Source: medicare.gov

Medicare Hospital Compare Quality of Care

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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

Federal Budget in Pictures

In 2016 the national debt exceeded $19 trillion. Now, more than ever it’s critical that we understand the nation’s spending, taxes and debt. These powerful charts enable all Americans to better understand the federal budget and identify important areas of reform.
Source: federalbudgetinpictures.com

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

Health Reform Implementation Timeline

Implementation update: On July 19, 2010, the Office of Consumer Information and Insurance Oversight (OCIIO) issued regulations on the new preventive benefits coverage requirements. These rules apply to new plans established on or after September 23, 2010. On August 1, 2010, the U.S. Preventative Services Task Force released its recommendations. On July 19, 2011, the Institute of Medicine released a report that recommended several women’s preventive services that should be included in health plans with no cost-sharing. On August 1, 2011, HHS issued interim final regulations on preventive services, including requirements that insurers cover birth control with no cost-sharing. On August 3, 2011, HHS issued an amendment to the final regulations. On February 15, 2012, HHS issued final rules “authorizing the exemption of group health plans and group health insurance coverage sponsored by certain religious employers from having to cover certain preventive health services.” Also on February 15, 2012, HHS issued an issue brief estimating that 54 million Americans had received preventive benefits without cost-sharing. On August 1, 2012, HHS began requiring most new and renewing health plans to provide women’s preventive health services, including contraception, with no cost-sharing. HHS issued a brief estimating that 47 million women will receive coverage for these services without cost sharing.”
Source: kff.org

Michigan health insurance plans

Posted by:  :  Category: Medicare

From the young to the young at heart, we have award-winning health insurance plans for Michigan individuals & families, small & large employers, Medicare and Medicaid members.
Source: priorityhealth.com

Enrolling in Medicare if you are turning 65 and do not receive Social Security or Railroad Retirement benefits

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through your or your spouse’s current job when you first become eligible for Medicare. You can enroll in Medicare without penalty at any time while you have group health coverage and for eight months after you lose your group health coverage or you (or your spouse) stop working, whichever comes first. Medicare coverage begins the first month after you enroll.
Source: medicareinteractive.org

4 Mistakes to Avoid When Enrolling in Medicare

3. Paying for prescription drug coverage in the Medicare “doughnut hole” that you don’t really need. A Medicare beneficiary lands in the doughnut hole this year when his total annual cost of medications (paid by the Medicare Part D plan and the individual) reaches $2,940. The beneficiary is then responsible for footing the bill for the cost of all medications until they exceed $4,750. (The doughnut hole is scheduled to close in 2020.)
Source: nextavenue.org

Enrolling in Medicare if you missed your Initial Enrollment Period

Period, which means you can enroll in Medicare without penalty at any time while you have group health coverage and for eight months after you lose your group health coverage or you (or your spouse) stop working, whichever comes first. Note If you are under 65, have Medicare due to
Source: medicareinteractive.org

Enrolling in Medicare Part B at 65 With FEHB Coverage

The information provided may not cover all aspect of unique or special circumstances, federal regulations, and financial information is subject to change. To ensure the accuracy of this information, contact your benefits coordinator and ask them to review your official personnel file and circumstances concerning this issue. Retirees can contact the OPM retirement center. Our article is not intended nor should it be considered investment advice and our articles and replies are time sensitive. Over time, various dynamic economic factors relied upon as a basis for this article may change. The advice and strategies contained herein may not be suitable for your situation and this service is not affiliated with OPM or any federal entity. You should consult with a financial or human resource professional where appropriate. Neither the publisher or author shall be liable for any loss or any other commercial damages, including but not limited to special, incidental, consequential, or other damages.
Source: fedretire.net

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 Plan Finder Glossary

Medication Therapy Management (MTM) Programs offer free services to eligible members of Medicare drug plans. These services help make sure that medications are working to improve their members’ health. Members can talk with a pharmacist or other health professional and find out how to get the most benefit from their medications. Members can ask questions about costs, drug reactions, or other problems. Each member gets their own action plan and medication list after the discussion. These can be shared with their doctors or other health care providers. Members who take different medications for more than one health condition may contact their drug plan to see if they’re eligible.
Source: medicare.gov

How to Use Medicare’s Plan Finder Tool

A summary page will appear listing the number of stand-alone Part D prescription-drug plans available in your area, the number of Medicare Health Plans with drug coverage; and the number of Medicare Health Plans without drug coverage. You’ll be given several options in the left column to refine your search — such as capping the amount of your monthly premium or limiting your annual drug deductible, but in most cases, it’s better not to refine your search at this point. Sometimes, for example, plans with lower premiums may charge higher co-payments for the drugs you take. It’s best to see the full list and then narrow your search when you can compare overall costs. Click on “prescription drug plans” to see the Part D plans (rather than “Medicare health plans,” which shows Medicare Advantage plans), then click “continue to plan results,” where you’ll see a list of the prescription drug options available in your area.
Source: kiplinger.com

Drug Finder: Find which 2016 Medicare Part D plans best covers your drugs

- Copay / Coinsurance – These figures apply to the initial coverage phase of your plan. This is the phase after the initial deductible has been met and before you reach the Coverage Gap (Donut Hole). Plans often cover drugs in “tiers”. Tiers are specific to the list of drugs covered by the plan. Plans may have several tiers, and the copay for a drug depends on which tier the drug is in. The drug Tier is shown to the left of this column. These cost sharing figures DO NOT necessarily apply to the Coverage Gap. The plan may have a separate copay/coinsurance for the same drug while in the Coverage Gap. There are two figures shown under this “Cost Sharing” category:
Source: q1medicare.com

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.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

Contact UnitedHealthcare®

If you are a Provider and require assistance, you may contact UnitedHealthcare plans by calling the toll-free General Provider line. Please do not call the Customer Service number listed throughout this website. Providers are routed by their Tax ID.
Source: uhcmedicaresolutions.com

How Medicare Advantage Plans work

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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

Compare Medicare Advantage Plans

Every person is different, so you’ll want to carefully research Medicare Advantage plan options in light of your specific health needs and budget. Keep in mind that plan costs, benefits, service areas, and provider networks may all change from year to year, so it’s a good idea to review your coverage every year and make sure it’s still a good fit for your situation. Taking the time to shop around and compare Medicare Advantage plan options in your area could save you money on out-of-pocket costs.
Source: ehealthinsurance.com

California Health Advocates

Posted by:  :  Category: Medicare

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 Advantage 2014 Spotlight: Plan Availability and Premiums

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While many organizations offer Medicare Advantage plans, a few – particularly Humana, United Healthcare, and the Blue Cross and Blue Shield (BCBS) affiliates – have particularly large geographic spread and these organizations historically account for a disproportionate share of enrollment. In 2014, 44 percent of available plans are being offered by one of these three firms or affiliates (Table A4).  Plans offered by these firms are available to most beneficiaries.  Nationwide, 83 percent of Medicare beneficiaries will have access to one or more Humana plans, 73 percent will have access to a BCBS affiliated plan (including BCBS plans offered by Wellpoint), and 68 percent will have access to a United Healthcare plan (Exhibit 5; Table A5).  The general availability of these firms’ products has not noticeably changed from 2013 to 2014.  However, the similarities in BCBS offerings from 2013 to 2014 obscure a decline in availability of BCBS branded Wellpoint plans (declining from 88 plans to 55 plans between 2013 and 2014), which is mostly offset by the growth in plans offered by other BCBS affiliates (growing from 205 plans to 233 plans between 2013 and 2014).
Source: kff.org

Medicare Premiums 2017 Health Insurance

Before the passage of the Affordable Care Act (ACA), in 2010, the U.S. Congress had to approve any proposals that would affect Medicare payment rates and program rules. But that will change in 2017, as the Affordale Care Act created the Independent Payment Advisory Board (IPAB), a 15-member panel that would be empowered to propose changes if Medicare exceeds spending growth thresholds. The IPAB’s proposals are intended to extend the solvency of Medicare, slow Medicare cost growth, and improve the quality of care delivered to Medicare beneficiaries. Any recommendations would automatically go into effect, unless Congress took steps to override them. According to the, Medicare Trustees, a group that oversees the financial operations of the Hospital Insurance and Supplementary Medical Insurance trust funds, the Medicare per capita growth rate is projected to exceed the per capita target growth rate in 2017, triggering the IPAB for the first time.  This means three in ten people will be hit with a 25% increase for Medicare Part B, and that 70% of people with Medicare will be exempt from paying. And, according to a recent report from the Medicare Trustees, because the law requires Medicare Part B premiums to cover 25% of program costs, the 30% of those with Medicare premiums will see an increase to at least $159.30 each month, and couples who earn $428,000 annually will pay a monthly premium of $509.80.
Source: medicarepremiums2017.com

Annual Statistical Supplement, 2011

Beginning January 1, 2006, upon voluntary enrollment in either a stand-alone PDP or an integrated Medicare Advantage plan that offers Part D coverage in its benefit, subsidized prescription drug coverage. Most FDA-approved drugs and biologicals are covered. However, plans may set up formularies for their drug coverage, subject to certain statutory standards. (Drugs currently covered in Parts A and B remain covered there.) Part D coverage can consist of either standard coverage or an alternative design that provides the same actuarial value. (For an additional premium, plans may also offer supplemental coverage exceeding the value of basic coverage.) Standard Part D coverage is defined for 2006 as having a $250 deductible, with 25 percent coinsurance (or other actuarially equivalent amounts) for drug costs above the deductible and below the initial coverage limit of $2,250. The beneficiary is then responsible for all costs until the $3,600 out-of-pocket limit (which is equivalent to total drug costs of $5,100) is reached. For higher costs, there is catastrophic coverage; it requires enrollees to pay the greater of 5 percent coinsurance or a small copay ($2 for generic or preferred multisource brand and $5 for other drugs). After 2006, these benefit parameters are indexed to the growth in per capita Part D spending (see Table 2.C1). In determining out-of-pocket costs, only those amounts actually paid by the enrollee or another individual (and not reimbursed through insurance) are counted; the exception is cost-sharing assistance from Medicare’s low-income subsidies (certain beneficiaries with low incomes and modest assets will be eligible for certain subsidies that eliminate or reduce their Part D premiums, cost-sharing, or both) and from State Pharmacy Assistance Programs. A beneficiary premium, representing 25.5 percent of the cost of basic coverage on average, is required (except for certain low-income beneficiaries, as previously mentioned, who may pay a reduced or no premium). For PDPs and the drug portion of Medicare Advantage plans, the premium will be determined by a bid process; each plan’s premium will be 25.5 percent of the national weighted average plus or minus the difference between the plan’s bid and the average. To help them gain experience with the Medicare population, plans will be protected by a system of risk corridors, which allow Part D to assist with unexpected costs and to share in unexpected savings; after 2007, the risk corridors became less protective. To encourage employer and union plans to continue prescription drug coverage to Medicare retirees, subsidies to these plans are authorized; the plan must meet or exceed the value of standard Part D coverage, and the subsidy pays 28 percent of the allowable costs associated with enrollee prescription drug costs between a specified cost threshold ($250 in 2006, indexed thereafter) and a specified cost limit ($5,000 in 2006, indexed thereafter).
Source: ssa.gov

AARP Medicare Supplement Insurance Premiums

Joan, If you initially worked with a local agent in Florida I would start there. You could call customer service but that will probably be a waste of time. If you are healthy and believe that you would have no problem passing medical underwriting, it may be time to shop. Medicare supplements offer standardized benefits so Plan F for instance will be the same for all companies. As you have learned, there is not necessarily a reward for staying with the same company. Most major companies offering supplements will offer the same level of service and payment of claims. Take this time to see if you can save some money. Call PlanPrescriber at (888) 310-0376 to speak with an agent. They represent most all carriers.
Source: affordablemedicareplan.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

How to Find a Medicare Number

Look at your social security card. Your social security number is the first part of your Medicare number for part A and B benefits. The second part is the letter A or B, depending on which benefit you are needing the number for. Part A is inpatient hospital benefits and Part B is outpatient medical benefits. For example, if your social security number is 111-22-3333, then your Medicare number for Part A benefits is 111-22-3333-A. If you do not have a social security card or your Medicare card, contact your local SSA office for a list of documents required for obtaining a replacement card.
Source: ehow.com

Coventry Medicare: Grievances & Appeals

How do I submit a Part C Organization Determination to request coverage for medical services? You, your doctor, or representative can call, fax or mail your request to us. Phone and Fax: Our contact information (phone number, address, and fax number) is available to you on the contact us page of this website and in the plan’s Evidence of Coverage (EOC). You can also call us using the number on the back of your ID card. Fax: 855-788-3994 Mail: Part C Appeal & Grievance P.O. Box 7776 London, KY 40742-7776 What can I do if my Part C Organization Determination request is denied? If we don’t cover or pay for your benefits or services, you, your doctor, or representative can appeal our decision. You need to submit your name, address, member number and reason for appealing. Any evidence you want us to review, such as medical records, doctor’s letter or other information that explains why you need the item or services, can be submitted. Call your doctor if you need this information . For a standard appeal, mail or fax deliver your appeal to: Part C Appeal & Grievance P.O. Box 7776 London, KY 40742-7776 Fax: 855-788-3994 For an expedited appeal: Phone: 866-613-4977 Fax: 855-788-3994 How do I submit a Coverage Determination for my prescription drug? If you’re a member, you can request an exception if a drug has a prior authorization, quantity limit or step therapy. Not an Aetna member yet? You can call 1-877-988-3589 (TTY: 711) to get answers to your questions. You, your doctor, or representative can submit the online form, or download the form for your type of plan, and fax or mail deliver your request to us. You may also call us. Submit online form If we don’t currently cover your medication or you need prior authorization before we cover your medication, you can ask for this coverage by completing one of the forms below: First Health Part D Prescription Drug Plans Medicare Advantage Plans Fax: 1-800-639-9158 Mail: Part D – Medicare Appeals & Grievances P.O. Box 7773 London, KY 40742 Phone: Our phone numbers (standard and expedited) are on the contact us page of this website, in the plan’s Evidence of Coverage (EOC), and on your ID card. What can I do if my Coverage Determination is denied? If we deny your Prescription Drug request, you can appeal our decision. You, your doctor, or representative can submit the online form, or download the form below and mail or fax deliver it to us. Submit online form Download: Request for Redetermination of Medicare Prescription Drug Denial Fax: 1-800-535-4047 Mail: Part D Medicare Appeals & Grievances – Redeterminations P.O. Box 7773 London, KY 40742 If your request needs to be “Expedited” you can call or fax us. Expedited Phone Line: 1-800-536-6167 Expedited Fax Number: 1-800-535-4047 What can I do if I have a complaint (also called a “grievance”)? If you have a complaint about your medical or pharmacy coverage, you, your representative , or your doctor can call, fax, or write to us. For Part C Appeal and Grievance: Phone : Our phone numbers are on the contact us page of the website, in the plan’s Evidence of Coverage (EOC), and on the back of your Member ID card. Mail: Part C Appeal & Grievance P.O. Box 7776 London, KY 40742-7776 Fax #: 855-788-3994 For Part D Appeal & Grievance: Phone : Our phone numbers are on the contact us page of the website, in the plan’s Evidence of Coverage (EOC), and on the back of your Member ID card. Fax #: 1-800-535-4047 Mail: Part D Appeal & Grievance P.O. Box 7773 London, KY 40742 You can contact the Office of the Medicare Ombudsman for help with a complaint, grievance, or information request. To learn more, visit https://www.medicare.gov/claims-and-appeals/medicare-rights/get-help/ombudsman.html. How long does it take to get a decision? You can request either a “Standard” or “Expedited” (fast) decision process. If your health requires it, you can ask us to give you a "fast coverage decision". A "fast coverage decision" is called an "expedited coverage determination" or an “expedited organization determination”. When we give you our decision, we will use the "standard" deadlines unless we have agreed to use the "fast" deadlines. We will respond to your request no later than the below timeframes. Request for an Coventry Medicare Advantage Plan (Part C) Organization Determination  Standard Process = Pre-service: 14 days     Claims: 60 days Expedited Process = Pre-service: 72 hours     Claims: n/a Request for a Coventry Medicare Advantage Plan (Part C) Organization Determination Denial Standard Process = Pre-service: 30 days Claims: 60 days Expedited Process = Pre-service: 72 hours Claims: n/a Request for Prescription Drug Coverage Determination Standard Process= 72 hours Expedited Process= 24 hours Request for Redetermination for a Coventry Medicare Prescription Drug Denial Standard Process= 7 days Expedited Process= 72 hours Coventry Medicare Advantage Plan Grievance Standard Process= 30 days Expedited Process= 24 hours Prescription Drug Plan Grievance Standard Process= 30 days Expedited Process= 24 hours
Source: coventryhealthcare.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

Guide to Completing Medicare Application and Claim Forms

Medicare Advantage plans vary, and they generally include Health Maintenance Organization (HMO) plans, Preferred Provider Organization (PPO) plans, Private Fee-for-Service (PFFS) plans, Special Needs Plans (SNPs), and Medical Savings Account (MSA) plans. You can enroll in a Medicare Advantage plan through the Medicare.gov website.  At the Medicare site, you can also download the payment information form to include with your application. In addition, Medicare.com offers a useful online resource to compare Medicare Advantage plans and then gives you access to the appropriate Medicare application form.
Source: medicare.com

Medicare enrolment application form (3101)

This information was printed Friday 9 September 2016 from humanservices.gov.au/customer/forms/3101 It may not include all of the relevant information on this topic. Please consider any relevant site notices at humanservices.gov.au/siteinformation when using this material.
Source: gov.au