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

Posted by:  :  Category: Medicare

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Source: medicare.gov

Big Driver of Medicare Spending: Doctors Doing More Tests in Their Offices

The top biller for the test in 2014, Brooklyn, N.Y., ophthalmologist Stanley Bykov, received $130,795 for it from Medicare that year, billing data show. He tested 84% of his Medicare patients at least once in 2014, compared with a median of about 11% for medical providers that the billing data show did the test. Medicare suppresses data for providers who bill for a service for 10 or fewer patients, and most eye specialists didn’t do the test at all on Medicare patients.
Source: wsj.com

Contact Information and Websites of Organizations for Medicare

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Source: medicare.gov

Guide to Medicare Supplement

The California Department of Insurance (CDI) regulates Medicare Supplement policies underwritten by licensed insurance companies. The CDI assists consumers in resolving complaints and disputes concerning premium rates, claims handling, and many other problems with agents or companies. The Consumer Hotline 800-927-4357 is serviced by experienced professionals who will answer your questions, or assist you in filing a complaint.
Source: ca.gov

Enforcement Branch Overview

To accomplish this mission, the Enforcement Branch investigates criminal and regulatory violations relating to insurance transactions from point-of-sale through the claims process. In addition, the Enforcement Branch administers five grant programs that provide funding to county district attorney offices to assist with their efforts to investigate and prosecute insurance fraud. Fraud Division administers four of the five grant programs:  Automobile Insurance Fraud, Urban Automobile Fraud Activity Interdiction; Disability and Healthcare Fraud, and Workers’ Compensation Insurance Fraud. Investigation Division administers the Life and Annuity Consumer Protection Program.
Source: ca.gov

The Medicare Part D Prescription Drug Benefit

Posted by:  :  Category: Medicare

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

Affordable Health Coverage

Rating and national average are based on Controlling High Blood Pressure 2013 ratings from the Healthcare Effectiveness Data and Information Set (HEDIS) for commercial plans published by the National Committee for Quality Assurance. HEDIS is a tool used by more than 90 percent of America’s health plans to measure performance on important dimensions of care and service. HEDIS is a registered trademark of the National Committee of Quality Assurance (NCQA). For more information, visit ncqa.org.
Source: kaiserpermanente.org

Healthcare business news, research, data and events from Modern Healthcare

Anxiety is rippling through the healthcare industry as the initial reporting period for Medicare’s new payment system for physicians fast approaches. Modern Healthcare’s latest CEO Power Panel survey reveals leaders are bracing for uncertainties and challenges generated by MACRA.
Source: modernhealthcare.com

Healthcare – Just Facts

[Under Medicare Part C] Most beneficiaries have the option to enroll in private health insurance plans that contract with Medicare to provide Part A and Part B medical services. The share of Medicare beneficiaries in such plans has risen rapidly in recent years, reaching 25.0 percent in 2010 from 12.4 percent in 2004. Plan costs for the standard benefit package can be significantly lower or higher than the corresponding cost for beneficiaries in the “traditional” or “fee-for-service” Medicare program, but prior to the Affordable Care Act [ACA, a.k.a. Obamacare], private plans were generally paid a higher average amount, and the additional payments were used to reduce enrollee cost-sharing requirements, provide extra benefits, and/or reduce Part B and Part D premiums. These benefit enhancements were valuable to enrollees but also resulted in higher Medicare costs overall and higher premiums for all Part B beneficiaries, not just those who were enrolled in MA plans. Under the ACA, payments to plans will be based on “benchmarks” in a range of 95 to 115 percent of fee-for-service Medicare costs, with bonus amounts payable for plans meeting high quality-of-care standards. (Prior to the ACA, the benchmark range was generally 100 to 140 percent of fee-for-service costs.) As these changes phase in during 2012-2017, the overall participation rate for private health plans is expected to decline from 25 percent in 2010 to about 15 percent in 2020.
Source: justfacts.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

Energy and Commerce Committee

Since 2013, the committee has been working on a bipartisan effort to support biomedical research and harness innovation to turn discoveries in a lab into the treatments and cures that change patients’ lives. We broke the mold with our approach to 21st Century Cures: We listened. We engaged. We solicited input. We drafted. We listened some more. It was an inclusive, unique, transparent process that culminated in legislation to safely speed the discovery, development, and delivery of new drugs and devices. H.R. 6, the 21st Century Cures Act, overwhelmingly passed the House and is now before the Senate. Learn more about the effort to deliver #CuresNow here.
Source: house.gov

Healthcare – Just Facts

[Under Medicare Part C] Most beneficiaries have the option to enroll in private health insurance plans that contract with Medicare to provide Part A and Part B medical services. The share of Medicare beneficiaries in such plans has risen rapidly in recent years, reaching 25.0 percent in 2010 from 12.4 percent in 2004. Plan costs for the standard benefit package can be significantly lower or higher than the corresponding cost for beneficiaries in the “traditional” or “fee-for-service” Medicare program, but prior to the Affordable Care Act [ACA, a.k.a. Obamacare], private plans were generally paid a higher average amount, and the additional payments were used to reduce enrollee cost-sharing requirements, provide extra benefits, and/or reduce Part B and Part D premiums. These benefit enhancements were valuable to enrollees but also resulted in higher Medicare costs overall and higher premiums for all Part B beneficiaries, not just those who were enrolled in MA plans. Under the ACA, payments to plans will be based on “benchmarks” in a range of 95 to 115 percent of fee-for-service Medicare costs, with bonus amounts payable for plans meeting high quality-of-care standards. (Prior to the ACA, the benchmark range was generally 100 to 140 percent of fee-for-service costs.) As these changes phase in during 2012-2017, the overall participation rate for private health plans is expected to decline from 25 percent in 2010 to about 15 percent in 2020.
Source: justfacts.com

Medicare & Medicaid Exclusion Screening Compliance

Posted by:  :  Category: Medicare

Most providers simply do not have the capability to download the LEIE (which contains almost 60,000 names) and compare it with their own employee database in any reliable, or economically viable way. Another issue is the requirement that providers apply the same standard to contractors and sub-contractors as to their own employees. Contractors are not likely to want to share their employee lists. Neither would a provider want to screen the employee list of a large contractor. Thus, while the OIG does seem to recognize the issue by suggesting that providers can “choose to rely screening conducted by the contractor,” it immediately follows the suggestion by reminding providers that they remain responsible for both overpayment liability and CMPs if they fail to ensure that “appropriate exclusion screening” had been done.
Source: exclusionscreening.com

The Medicare Dental Exclusion: Is it Being Used to Deny Vulnerable Beneficiaries Needed Care? 

It is essential that a multidisciplinary approach be used for oral management of the cancer patient before, during, and after cancer treatment. A multidisciplinary approach is warranted because the medical complexity of these patients affects dental treatment planning, prioritization, and timing of dental care. In addition, selected cancer patients (e.g., status post treatment with high-dose head-and-neck radiation) are often at lifelong risk for serious complications such as osteoradionecrosis of the mandible. Thus, a multidisciplinary oncology team that includes oncologists, oncology nurses, and dental generalists and specialists as well as dental hygienists, social workers, dieticians, and related health professionals can often achieve highly effective preventive and therapeutic outcomes relative to oral complications in these patients.[7]
Source: medicareadvocacy.org

Health Insurance, Medicare Insurance and Dental Insurance

Posted by:  :  Category: Medicare

At Humana, we go beyond insurance. We help provide a roadmap to a healthier you. By taking a personalized look at your life and your health, we can help you find the perfect plan and achieve your goals. Start becoming your best you. Start with healthy.
Source: humana.com

Electronic Health Records (EHR) Incentive Programs

The American Recovery and Reinvestment Act of 2009 (ARRA) (Pub.L. 111–5) was enacted on February 17, 2009. Title IV of Division B of ARRA amends Titles XVIII and XIX of the Social Security Act (the Act) by establishing incentive payments to eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs), and Medicare Advantage Organizations to promote the adoption and meaningful use of interoperable health information technology (HIT) and qualified electronic health records (EHRs). These incentive payments are part of a broader effort under the HITECH Act to accelerate the adoption of HIT and utilization of qualified EHRs.
Source: cms.gov

Health Insurance, Medicare Insurance and Dental Insurance

Posted by:  :  Category: Medicare

At Humana, we go beyond insurance. We help provide a roadmap to a healthier you. By taking a personalized look at your life and your health, we can help you find the perfect plan and achieve your goals. Start becoming your best you. Start with healthy.
Source: humana.com

Glossary of Dental Clinical and Administrative Terms

prompt payment laws: Also known as fair claims practice regulations. Enacted state by state, prompt payment laws set standards for the prompt, fair and equitable settlements of insurance claims by requiring that a set amount of interest be paid on “clean claims” that are paid beyond the established timeframe. “Clean claim” means a claim for payment of covered health care expenses that is submitted to a payer on the carrier’s standard claim form using the most current published procedural codes, with all the required fields completed with information sufficient to adjudicate the claim in accordance with the payer’s published filing requirements. These laws need to be analyzed on a case by case basis to determine whether a lawsuit has to be filed by the state department of insurance.
Source: ada.org

EmblemHealth: Family & Individual Health Insurance Plans In New York

If you need help determining the best place to seek care, call our toll-free Nurse Advice Line at 1-877-444-7988 to speak with a registered nurse without waiting for a call back. A registered nurse can guide you to the help you need now. This service is available 24 hours a day, seven days a week.
Source: emblemhealth.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

Health Insurance, Medicare Insurance and Dental Insurance

At Humana, we go beyond insurance. We help provide a roadmap to a healthier you. By taking a personalized look at your life and your health, we can help you find the perfect plan and achieve your goals. Start becoming your best you. Start with healthy.
Source: humana.com

Find and compare Nursing Homes

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Source: medicare.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

UnitedHealthcare Medicare Insurance Plans

Medicare Advantage Plans from UnitedHealthcare not only replace your Original Medicare benefits but also provide prescription drug benefits. The company offers four different types of Medicare Advantage Plans, which are Health Maintenance Organization (HMO), Point-of-Service (POS), Preferred Provider Organization (PPO), and Private Fee-for-Service (PFFS) Plans. The brand names for its plans vary and depend on where you live and the options that are available to you.
Source: medicaresolutions.com

Compare Medicare Advantage & Supplemental Plans

Posted by:  :  Category: Medicare

Medicare Advantage insurance is offered by private insurance companies with a Medicare contract, and replaces Original Medicare Part A and Part B. You must continue to pay your Part B premiums. Medicare Advantage plans typically offer additional benefit options and have less cost-sharing than Original Medicare, and you may have to pay a monthly premium in return for the extra benefits. Medicare Advantage plans come in a variety of formats, such as HMO, PPO and PFFS plans, as well as special needs plans. Medicare beneficiaries can enroll in Medicare Advantage plans if they have Medicare Part A and Part B, but only during designated enrollment periods. These enrollment periods change from time-to-time, so please call us to get the most-up-to-date information.
Source: medicaresolutions.com

Compare Medicare Supplement (Medigap) Plans and Rates in Your Area

"Times have changed since my mother had an AARP J plan and I was totally confused by the options available. Stan walked me through the process in a very educational, methodical, friendly way, and I feel secure now that we’re making the correct decision to provide the best possible coverage for my husband." – Pat K.
Source: medigap360.com

Medicare Supplemental Policies: Do You Need One?

We’ll start with what they cover. Supplemental insurance is sold to cover “what Medicare doesn’t.” Remember I said that wasn’t quite true. Unless a supplemental policy specifically states otherwise, the most it will cover are the Medicare deductibles ($147 outpatient and $1,187 hospitalization) and the 20 percent co-insurance. Supplemental policies do not usually cover any medical services Medicare won’t cover. What’s more, Medicare supplemental insurance will only pay health care providers what you would pay if you didn’t have the supplemental policy. Providers aren’t paid any more for taking care of you if you have one of these policies.
Source: huffingtonpost.com

Medicare Supplemental Insurance — Which policy is best?

Our recommendation: After picking the benefit combination (Plan A through L) that best suits your needs, buy the issue-age or community-rated Medigap policy with the lowest premium. Even though they are a bit more expensive at the start, your premiums won’t go up every year just because you get older. (AARP’s Medigap plans use a combination of issue-age and community-rated methods; their premiums don’t increase as you get older, but their younger retirees do receive a discount.)
Source: todaysseniors.com

Welcome to Maine Medicare Options!

Posted by:  :  Category: Medicare

The benefit to you is that I am a “One-Stop Shop.”   When you sit down with me we will review your specific needs and match you up with the plans that best meet those needs.  I will help you narrow down those choices to one plan by answering all your questions so you can make the best choice for you and feel confident knowing that you have chosen the right plan.  I will also help you enroll in the plan and as your agent, I will be there with you during the entire process of enrollment.  I am also available to you during the year any time you have questions or need direction.  Medicare is very complex and it is a great relief to know you have someone in your corner every step of the way.   Every year Medicare Advantage and Part D Prescription Drug plans can change and as your agent, I will talk with you or meet with you before your plan changes.  We will review all changes and if necessary help you to find a new plan that suits your needs best.  I will never pressure you or suggest you change plans.  That decision is always yours to make.   I am simply here as a guide to help you make an informed decision.  I am well respected among my peers and maintain a good reputation. I build meaningful relationships with the people I meet and offer exceptional customer service.
Source: mainemedicareoptions.com

About Maine SHIP: Medicare Assistance: Support in the Community: Office of Aging And Disability Services

If you have Medicare insurance, or expect to have it soon, you may have questions or need help to understand your Medicare benefits. Trained health insurance counselors are available throughout Maine to provide you information about Medicare and other health insurance issues. You can also learn about programs in Maine that help lower the cost of prescription drugs and other out-of-pocket medical expenses. SHIP services are free, confidential and available to older people and people who have Medicare because of a disability. SHIP Counselors do not sell insurance or recommend policies.
Source: maine.gov

Southern Maine Agency on Aging

One-on-one health insurance counseling appointments can be scheduled after you have attended a Welcome to Medicare Seminar. These appointments will pair you with a trained State Health Insurance Program (SHIP) counselor who is either a Southern Maine Agency on Aging staff member or a highly-trained volunteer. All counselors are highly-skilled and trained to provide support and assistance to Medicare beneficiaries in understanding their plan choices. All Medicare beneficiaries are encouraged to review their plans yearly. One-on-One Medicare Appointments are offered at the following locations:
Source: smaaa.org

Get Medicare Part D Quotes in Seconds

As could be expected, prices for Humana policies rocketed for the 2015 calendar year. Mean premiums for Humana Part D jumped from $21.80 to $38.70. Medicare Part D is priced at $41.55 and Part D Medicare comes in at the slightly lower price of $38.80. Humana’s standalone market share coverage has dropped to 18.6% whereas their Medicare Part D policies have increased to a market share of 12.8%.
Source: medicareaide.com