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

What does Medicare cover (Parts A, B, C, and D)?

companies to provide Medicare benefits. These Medicare private health plans, such as HMOs and PPOs, are known as Medicare Advantage Plans. If you want, you can choose to get your Medicare coverage through a Medicare Advantage Plan instead of through Original Medicare.
Source: medicareinteractive.org

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

MyMedicare.gov: Customer Service

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Source: mymedicare.gov

Medicare Phone Number: Shorter Wait, Best Support

If you’re already on the phone with Medicare, you may want to look over any tips we have for getting better results. If you already talked to a Medicare rep (or several), let us know if you were able to resolve your issue and how your experience was- it’s how we customers push companies like Medicare to give better customer support.
Source: gethuman.com

Costs in the coverage gap

Posted by:  :  Category: Medicare

If you think you’ve reached the coverage gap and you don’t get a discount when you pay for your brand-name prescription, review your next “Explanation of Benefits” (EOB). If the discount doesn’t appear on the EOB, contact your drug plan to make sure that your prescription records are correct and up-to-date. Get your plan’s contact information from a Personalized Search (under General Search), or search by plan name. If your drug plan doesn’t agree that you’re owed a discount, you can file an appeal.
Source: medicare.gov

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

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

Donut Hole, Medicare Prescription Drug

Most plans with Medicare prescription drug coverage (Part D) have a coverage gap (called a “donut hole”). This means that after you and your drug plan have spent a certain amount of money for covered drugs, you have to pay all costs out-of-pocket for your prescriptions up to a yearly limit. Once you have spent up to the yearly limit, your coverage gap ends and your drug plan helps pay for covered drugs again.
Source: healthcare.gov

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

How does this Donut Hole really work?

I use medications not covered by my Medicare Part D plan or sometimes I buy my medications from outside of the country (for instance, in Canada or Mexico). Are these prescription drug expenses included in the $3310 or any other Part D calculation? No. Any medications not included on your Medicare Part D plan’s formulary or drug list (also known as: out of formulary drugs) or drugs that you purchased outside of the United States fall outside of your Medicare Part D coverage and are not included in the $3310 or any other Part D calculation. If you use a medication that is not included on your formulary, you can ask your Medicare Part D plan for a formulary exception or coverage determination, whereby your non-formulary drug would be included on your own personal formulary. If your Medicare Part D plan denies your request for a coverage determination, you can appeal the denial – several times. Be sure to ask your Medicare Part D plan for details on the formulary exception and appeals process.
Source: q1medicare.com

Travel Guard: Travel Insurance for Trip Cancellation, Medical/Health & Accident Coverage, Flight Delays, Hurricane and Tropical Storms from TravelGuard.com

Posted by:  :  Category: Medicare

Travel Guard is committed to providing products and services that will exceed expectations. If you are not completely satisfied, you can receive a refund of the cost, minus the service fee. Requests must be submitted to Travel Guard in writing within 15 days of the effective date of the coverage, provided it is not past the original departure date. Not applicable to residents of the state of New York.
Source: travelguard.com

Insurance Quotes and Comparison

Finding the cheapest policy is easy when you know what all of your options are. That’s why we bring you multiple quotes with just a single form – to make shopping for car insurance as easy as it should be. We’ll even help you find hidden discounts and explore bundling options, so you can save even more.
Source: insurance.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 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

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

Australian Government Department of Human Services

This information was printed Friday 30 September 2016 from humanservices.gov.au/ 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

Decision Memo for Screening for Lung Cancer with Low Dose Computed Tomography (LDCT) (CAG

The NLST demonstrated benefit by enrolling a large number of high exposure patients (smoking history) to be followed for several years to detect a significant decrease (247 deaths from lung cancer per 100,000 person-years in the low-dose CT group and 309 deaths per 100,000 person-years in the radiography group; number needed to screen (NNS) to prevent one lung cancer death = 320).  The trial was ended early after an interim analysis.  The decision to compare to screening with chest radiology (Church, 1990) was made before the PLCO trial was completed that showed chest radiology did not reduce lung cancer mortality (Oken, 2011); however, the radiology group was exposed to harms that may not have occurred in a no screening control, potentially enhancing the relative benefits and the likelihood of a positive trial result.  The harms of LDCT relate to the CT scan itself and the follow-up diagnostic tests or interventions (adverse events from bronchoscopies and biopsies), and patient psychosocial consequences, and have been recognized for many years as noted in past USPSTF reviews.  For example, death within 60 days after most invasive diagnostic procedures was twice as high in the radiology group compared to the LDCT group (2.1 % versus 1.0 %; NLST, 2011), which with a large sample size may result in a meaningful difference.  NLST investigators wrote:  “one of the most important factors determining the success of screening will be the mortality associated with surgical resection, which was much lower in the NLST than has been reported previously in the general U.S. population (1 % vs. 4 %).”  If this is not maintained with broad implementation of screening, the screening benefits may not be realized.  A better understanding of why patients screened with LDCT had lower mortality from invasive procedures is needed.  Questions such as whether the state of disease, patient, physician, or bias of either the physician/practitioner or patient may need to be considered.   
Source: cms.gov

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

Posted by:  :  Category: Medicare

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

Ohio Department of Health Home

ODH’s Office of Health Assurance and Licensing regulates many types of health care facilities through both state licensure and federal certification rules. The Bureau of Long Term Care ensures the quality of care and quality of life of the residents of nursing homes and Residential Care Facilities (RCFs), also known as assisted living facilities, by conducting on-site inspections/surveys for compliance with state and federal rules and regulations in nursing homes/facilities. Need to file a complaint against a nursing home or other health care facility? Call our hotline at 1-800-342-0553 or Complaint Form.
Source: ohio.gov

The United States Social Security Administration

Posted by:  :  Category: Medicare

Social Security provides financial benefits, tools, and information to help support you throughout life’s journey. We’re excited to announce the launch of geospatial mapping at Social Security! Our new initiative, GeoMaps, complements…
Source: ssa.gov

Social Security (United States)

Due to changing needs or personal preferences, a person may go back to work after retiring. In this case, it is possible to get Social Security retirement or survivors benefits and work at the same time. A worker who is of full retirement age or older may (with spouse) keep all benefits, after taxes, regardless of earnings. But, if this worker or the worker’s spouse are younger than full retirement age and receiving benefits and earn “too much”, the benefits will be reduced. If working under full retirement age for the entire year and receiving benefits, Social Security deducts $1 from the worker’s benefit payments for every $2 earned above the annual limit of $15,120 (2013). Deductions cease when the benefits have been reduced to zero and the worker will get one more year of income and age credit, slightly increasing future benefits at retirement. For example, if you were receiving benefits of $1,230/month (the average benefit paid) or $14,760 a year and have an income of $29,520/year above the $15,120 limit ($44,640/year) you would lose all ($14,760) of your benefits. If you made $1,000 more than $15,200/year you would “only lose” $500 in benefits. You would get no benefits for the months you work until the $1 deduction for $2 income “squeeze” is satisfied. Your first social security check will be delayed for several months—the first check may only be a fraction of the “full” amount. The benefit deductions change in the year you reach full retirement age and are still working—Social Security only deducts $1 in benefits for every $3 you earn above $40,080 in 2013 for that year and has no deduction thereafter. The income limits change (presumably for inflation) year by year.
Source: wikipedia.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

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

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

The GAO has released what’s being called a “scathing” report on cybersecurity readiness and threats in health IT. The agency says HHS’ investigations often result in technical advice that is not pertinent and that the agency doesn’t always follow up to ensure corrective actions have been taken.
Source: modernhealthcare.com

Does Medicare Pay for Assisted Living

Posted by:  :  Category: Medicare

I can promise you that here in Alabama, Medicare pays for NOTHING when it comes to Assisted Living. In fact, with my Mom, who is in the final stages of Alzheimer’s, it has been an act of God for Medicaid to help us. While Mom was in the Assisted Living since 2005, my family has gone through every cent of savings, 401k, and paychecks trying to meet the bill every month. The bottom line is the law needs to change. The people with Alzheimer’s, as well as their families need some sort of re-course. As for Medicaid, every time we turn in the paper work (4 times now), if they even acknowledge they have received the paperwork, they have sent us back a letter saying they need something else. It has gotten so bad, that we are now hand delivering all paperwork and keeping copies of everything. Why they don’t have a list of everything you are going to need posted, is a major concern. I think my Mom will pass away before Medicaid gets around to approving her case. What’s more difficult is the Nursing Home side of facilty cost us $5000 / month where as the Assisted Living was $3200 / month. Since we haven’t won the lottery, this increase hurts tremendously. Mom has to have the 24 hour care, there is no choice but to pay it.
Source: caring.com

Medicaid & Medicare For Assisted Living & Nursing Home

As a Medicaid-approved provider of assisted living and nursing care, Hovnanian Senior Housing Services is eligible to provide housing to Medicaid beneficiaries. Let us help you review your housing and medical care needs and which services Medicaid or Medicare will assist you with. We can help you untangle the Federal and State eligibility rules that apply to your individual situation.
Source: hovnanianseniorhousing.com

Assisted Living Facilities .org

AssistedLivingFacilities.org strives to serve as the informational resource for assisted living in the United States. We list information on over 36,400 state-licensed assisted living facilities and try to explain the rules and regulations of each state. We try to offer as much useful information as possible to help you decide if assisted living is a good option, and if so, to select the best facility possible.
Source: assistedlivingfacilities.org

Assisted Living: MedlinePlus

Assisted living is for adults who need help with everyday tasks. They may need help with dressing, bathing, eating, or using the bathroom, but they don’t need full-time nursing care. Some assisted living facilities are part of retirement communities. Others are near nursing homes, so a person can move easily if needs change.
Source: medlineplus.gov

Invest in Senior Care, Assisted Living & Medicare Stocks

The 79 million Baby Boomers are getting older, living longer, and they want to see the doctor.1 Their generation is 27% bigger than the preceding group.2 Not to mention rising medical costs would mean they’ll have to pay more than their parents did for similar healthcare. A longer life expectancy means they’ll also require more services like surgeries, treatments and long-term therapies for their ailing hearts, broken bones, diabetes, and other privileges of aging.
Source: motifinvesting.com

Workers’ compensation and payments

Posted by:  :  Category: Medicare

If you settle your workers’ compensation claim, you must use the settlement money to pay for related medical care before Medicare will begin again to pay for related care. In many cases, the workers’ compensation agency contacts Medicare before a settlement is reached, to ask Medicare to approve an amount to be set aside to pay for future medical care. Medicare will look at certain medical documentation and approve an amount of money from the settlement that must be used up first before Medicare starts to pay for related care that’s otherwise covered and reimbursable by Medicare.
Source: medicare.gov

MSA Frequently Asked Questions

A WCMSA meets CMS’ criteria for review when: A.The Claimant is currently a Medicare beneficiary and the total settlement value is greater than $25,000. -or- B. The Claimant has a “reasonable expectation“ of Medicare enrollment within thirty (30) months of the settlement date and the anticipated total settlement amount for future medical expenses and disability/lost wages over the life or duration of the settlement agreement is expected to be greater than $250,000. Claimants have a “reasonable expectation” of enrollment where: (1) The claimant has applied for Social Security Disability Benefits. (2) The claimant has been denied Social Security Disability Benefits but anticipates appealing that decision. (3) The claimant is in the process of appealing a denial of or re-filing for Social Security Disability benefits. (4) The claimant is 62 years and 6 months old. (5) The claimant has an End-Stage Renal Disease (ESRD) condition but does not yet qualify for Medicare based upon ESRD. CMS has noted that while they do not wish to review WCMSAs if the thresholds are not met, these thresholds reflect a CMS operational workload standard only. They do not constitute a substantive dollar or “safe harbor” threshold. Medicare beneficiaries must still consider Medicare’s interests in all WC cases and ensure that Medicare is secondary payer to workers’ compensation. 5/11/11 Memorandum, Charlotte Benson, Acting Director, Financial Services Group. See also, WCMSA Reference Guide, cms.gov
Source: atlassettlements.com

Workers’ Compensation Medicare Set Aside Arrangements

The page could not be loaded. The CMS.gov Web site currently does not fully support browsers with “JavaScript” disabled. Please enable “JavaScript” and revisit this page or proceed with browsing CMS.gov with “JavaScript” disabled. Instructions for enabling “JavaScript” can be found here. Please note that if you choose to continue without enabling “JavaScript” certain functionalities on this website may not be available.
Source: cms.gov

Enterprise Risk Management & Claim Settlement Solutions for Insurance & Financial Industries.

What is a Medicare Set Aside? Under Section 1862 42 U.S.C. §1395y(b)(2) and § 1862(b)(2)(A)(ii) of the Social Security Act, Medicare is not responsible for paying a qualified injured person’s medical expenses when payment “has been made or can reasonably be expected to be made under a workers’ compensation plan, an automobile or liability insurance policy or plan (including a self-insured plan), or under no-fault insurance.” If the medical expenses are disputed in a personal injury situation, the provider, physician, or other supplier may bill Medicare as the primary payer. If the product or service is normally reimbursable under Medicare rules, Medicare may pay the expenses conditionally. Then if there is a subsequent settlement, judgment, award, or other payment, Medicare requires reimbursement of the expenses. For more information about your unique situation, ask our experts!
Source: msariskpro.com