S.C. Department of Health & Environmental Control

Posted by:  :  Category: Medicare

DHEC health departments typically follow county openings and closings. Due to the impact of Hurricane Matthew and ongoing shelter operations, some health departments in the Pee Dee and Lowcountry are operating at limited capacity. Call your local health department before coming in for services.
Source: scdhec.gov

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

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

Physicians for a National Health Program

Business owner Richard Master knows firsthand how the dysfunctional U.S. health care system punishes not only patients, but also employers who are forced to spend more and more to insure their workers. His documentary, “Fix It,” makes a strong business case for addressing this festering problem, and includes interviews with many PNHP members. A trailer for the film can be accessed above, or you can view the full version for free by visiting the “Fix It” website.
Source: pnhp.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

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

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

The Office of the National Coordinator for Health IT has finalized a rule giving it more oversight over certifying EHRs and other technologies that store, share and analyze health information for consumers. It also gained the authority to ask developers to pull noncompliant products from the market.
Source: modernhealthcare.com

Physicians for a National Health Program

Business owner Richard Master knows firsthand how the dysfunctional U.S. health care system punishes not only patients, but also employers who are forced to spend more and more to insure their workers. His documentary, “Fix It,” makes a strong business case for addressing this festering problem, and includes interviews with many PNHP members. A trailer for the film can be accessed above, or you can view the full version for free by visiting the “Fix It” website.
Source: pnhp.org

Consumer Information and Insurance Oversight

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

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

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

Top 10 Reasons People Hate Dentists

I disagree. My hatred of dentists is perfectly valid and ingrained over and over by the dentists themselves. Im 48 and I approach all new people with the view that they are individuals and I give them plenty of chances to prove they are decent . When it comes to dentists I have met only one who was honest about the things he could do for me and did not try to make money out of me. I take care of my teeth and gums very well but at 16 my front tooth was damaged in an accident. As a result I had to have a crown and it was that dentist, at the age of 18 who was and still is the only dentist I respect. From then on the dentists I have seen and had to have work done by have all had behaved like complete crooks. They lie about the work I need on the crown, saying it had to be replaced when it didnt need to be removed at all. They say they are good at cosmetic dentistry to get the money but they arent any good and nor re their technicians. I was given a crown to replace my origianl crown that left me looking like Bugs Bunny. The crown didnt need replacing, he lied to get the cash. All dentists since the original one are rude, they keep their backs to me when I have entered the room. They spend more time filling in forms thn treating me and this is true of all dentists. I have met more than ten in my search for a dentist who isnt rude, doesnt lie to me about their abilities and get me to spend money when the treatment isnt necssary. Most dentists are greedy and very above themselves.One dentist I had to leave when she routinely overbooked me with other patients and always kept me waiting at least an hour beyond my appointment time.When I confronted her she said she wouldnt do it anymore so basically admitted she overbooked patients to make money. They have sent me back into the waiting room after giving me an injection and treated someone else whilst my injection starts to work. My current dentist refuses to clean my teeth as they are in such a good condition and said I will have to pay a hygienist £35 an hour to get them cleaned privately!!! She hasnt cleaned my teeth in three years. One dentist actually had a stand up argument with me when I called him out on wanting to replace my crown because of a little bit of gum recession above it. I knew and so did he that all he had to do was add a bit of cosmetic filler in there and harden it. He actually agreed with me, after rowing with me, that it was the better option. Again, he saw pound signs. Another dentist left me in agony after a filling and refused to gve me painkillers or to re examine the filling. After i complained to the head of the practice his colleague treated me and got rid of the pain for me in minutes. The colleague said the filling was infected and I should have been treated sooner. I did get an apology from the original dentist, he did say that sometimes dentists need a telling off as they forget that they are treating people & just see teeth, but again, the damage was done. I have zero trust in dentists as they all want to get rich, thats why they all wnat to do dental implant courses, so they can make more money and wreck peoples lives.
Source: hatedentists.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

What’s Medicare Supplement Insurance (Medigap)?

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

Medicare Part D Coverage Gap (“Donut Hole”)

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

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

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

About the Medicare Coverage Gap

The Medicare coverage gap is the phase of your Medicare Part D benefit when there is a gap in prescription drug coverage. During this phase, you will have to pay more for your drugs, until you reach the catastrophic coverage phase. Most Medicare Advantage Prescription Drug plans and Medicare Prescription Drug Plans have a coverage gap, or “donut hole.” The coverage gap is reached when your total drug costs (what you and your plan pay) reach a certain amount. You then pay for your prescriptions out of pocket until entering the plan’s catastrophic coverage phase. This is when your total out-of-pocket costs, including the annual deductible and copayments/coinsurance, reach $4,850 in 2016.
Source: medicare.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.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

Extra Help with Medicare Prescription Drug Plan Costs

Medicare beneficiaries can qualify for Extra Help with their Medicare prescription drug plan costs. The Extra Help is estimated to be worth about $4,000 per year. To qualify for the Extra Help, a person must be receiving Medicare, have limited resources and income, and reside in one of the 50 States or the District of Columbia.
Source: ssa.gov

Physicians for a National Health Program

Business owner Richard Master knows firsthand how the dysfunctional U.S. health care system punishes not only patients, but also employers who are forced to spend more and more to insure their workers. His documentary, “Fix It,” makes a strong business case for addressing this festering problem, and includes interviews with many PNHP members. A trailer for the film can be accessed above, or you can view the full version for free by visiting the “Fix It” website.
Source: pnhp.org

Costs for Medicare drug coverage

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 Part D Formulary List and Drug Costs

SilverScript covers both brand name drugs and generic drugs. Generic drugs have the same active-ingredient formula as their brand-name equivalents. Generic drugs usually cost less than brand-name drugs and are rated by the U.S. Food and Drug Administration (FDA) to be as safe and effective as brand name drugs. We may remove drugs from the SilverScript Medicare Part D formulary, add prior authorization, quantity limits and/or step therapy restrictions on a drug, and/or move a drug to a higher cost-sharing tier during the plan year. If the change affects a drug you take, we will notify you at least 60 days before the change is effective. However, if the U.S. Food and Drug Administration (FDA) deems a drug on our formulary to be unsafe, or if the drug’s manufacturer removes the drug from the market, we may immediately remove the drug from the SilverScript Medicare Part D formulary and notify all affected members as soon as possible.
Source: silverscript.com

Medicare Advantage Drug Formulary

Generally, if you are taking a drug that was covered at the beginning of the year, we will not discontinue or reduce coverage of the drug during the coverage year except when we receive information from the FDA that a drug is no longer safe or effective. Complete information about these changes is included in the formulary documents above. Group Health Medicare Advantage plans cover both brand name drugs and generic drugs. Generic drugs have the same active-ingredient formula as a brand name drug. Generic drugs usually cost less than brand name drugs and are rated by the Food and Drug Administration (FDA) to be as safe and effective as brand name drugs.
Source: ghc.org

Medicare Advantage Plan Formularies (Drug Lists)

Coverage limitations: To be covered, drugs must be prescribed for a use that is approved by the FDA or documented in at least one of the specific peer-review compendia identified by the Centers for Medicare and Medicaid Services (CMS). You can find out if any additional prescription drug coverage limitations apply to your drugs by looking at the Prior Authorization. Prior authorization requires you or your doctor to get approval from the plan before your drug is covered. View the prior authorization criteria PDF below that applies to your plan to determine if the drug is covered. You will need the free Adobe
Source: uhcmedicaresolutions.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

State of Oregon: Medicare Help

Posted by:  :  Category: Medicare

​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​
Source: oregon.gov

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

Oregon Medicare & Medical Plans

The price for your health plan is the same whether you let us help you or not. Working with an agent that represents many different plans helps you get objective advice and extra service.   This way you’re not just a number… you’re a person that we care about.
Source: oregonmedicareplans.net

Health Reform Implementation Timeline

Posted by:  :  Category: Medicare

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

Custom care & coverage just for you

* Kaiser Foundation Health Plans, Inc., received the highest numerical score among commercial health plans in California, Colorado, and the South Atlantic, Mid-Atlantic, and Northwest regions in the J.D. Power 2016 Member Health Plan Study. Study based on 31,867 responses measuring experiences and perceptions of members surveyed October-December 2015. Your experiences may vary. Visit jdpower.com
Source: kaiserpermanente.org

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

A list of 19 top pharmaceutical companies ranked by the percentage of revenue spent on research in 2015. Companies listed make one or more of the top 50 drugs by total payments from the Medicare Part D program. Source: Modern Healthcare databases and Securities and Exchange Commission filings. A…
Source: modernhealthcare.com

How Kaiser Permanente treats people who complain — you could be next

Mr. Halvorson has been sending out weekly email updates to all of his employees, and whenever the opportunity presents itself he makes a point of saying something similar to this quote from his 5-year anniversary post: “As an organization of caregivers, we all feel collective pain any time we mis-deliver care.” Every chance he gets, he also likes to repeat that he sympathizes with people who have been harmed when a mistake has been made. But actions speak louder than words, and the reality of how Kaiser treats everyone who complains certainly doesn’t include the kind of sympathy that involves willingly making restitution to anyone whose life has been destroyed by Kaiser; or even acknowledging any wrongdoing, as Attorney Parks made perfectly clear. We haven’t been able to find one single Kaiser member who has been treated like a human being in a dispute with this “sympathetic” organization, and believe me, we have been actively trying.
Source: kaiserthrive.org

Medicare Eligibility When Disability Benefits Stop Due to Work

Posted by:  :  Category: Medicare

Hello. My SSDI payment (should) will stop because I had earnings over the limit for October, November and now December. I reported the increased earnings in October and they finally sent me the paperwork acknowledging my increase. I believe my work will continue at higher than SGA. I am now filling out the “work review” paperwork but have not received anything about a medical review yet. I am well past my TWP (ended in 2008) and the 36 month extended entitlement period. How quickly do they terminate (shut off) my Medicare? They still sent me a check in November so I know I will have to return the funds. I have still been using my Medicare insurance. But, I feel that I am back to work now and would no longer meet the disability requirements in a medical review (which is a very good thing!) So if I have to re-apply for Medicare since I am with in the 93 months I wouldn’t get it since I work above SGA and would not pass the medical review. Do they turn off my Medicare instantly or will it be good at least until they notify me they have terminated it or will they back date the termination to October 1 and deny any claims out there? Or, will it still be active while I go thru the current work review paperwork or while I go thru a future medical review? Thanks!
Source: disabilityadvisor.com

Medicare Eligibility Requirements

For people with end-stage renal disease (ESRD), you’re eligible for Medicare if your condition requires a kidney transplant or regular dialysis treatment. In order to qualify for Medicare, you also need to be eligible for or already receiving Social Security or Railroad Retirement Board benefits, or you need to have worked long enough under Social Security, the Railroad Retirement Board, or as a government worker. You can also qualify for Medicare if you’re the spouse or dependent of someone who is eligible for Social Security or Railroad Retirement benefits.
Source: medicareconsumerguide.com