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

How Medicare works with other insurance

Posted by:  :  Category: Medicare

A conditional payment is a payment Medicare makes for services another payer may be responsible for. Medicare makes this conditional payment so you won’t have to use your own money to pay the bill. The payment is “conditional” because it must be repaid to Medicare if you get a settlement, judgment, award, or other payment later. You’re responsible for making sure Medicare gets repaid from the settlement, judgment, award, or other payment.
Source: medicare.gov

What is Medicare Secondary Payor (MSP)?

Working Aged (age 65+) – GHP coverage is through the beneficiary’s or spouse’s current employment and the employer has 20 or more employees. End Stage Renal Disease (ESRD) – – GHP coverage is through the beneficiary’s or family member’s current or former employment, including COBRA coverage.  Medicare is secondary for a 30 month coordination of benefit period.
Source: cgsmedicare.com

When is Medicare the primary payer and when is it the secondary payer?

Although employers have the right to end COBRA coverage when you enroll in Medicare, some employers choose to continue COBRA. If your COBRA coverage continues when you enroll in Medicare, then Medicare is primary. This is only true if you qualify for Medicare based on age or disability. If you enroll in Medicare because of ESRD, and your employer does not end COBRA, then COBRA is primary and Medicare is secondary during the 30-month coordination period.
Source: medicareinteractive.org

J5 MAC Part B Provider Home Page

Posted by:  :  Category: Medicare

Applicable FARSDFARS Restrictions Apply to Government Use. This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60654. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (November 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements.
Source: wpsmedicare.com

Ways to pay Part A & Part B premiums

4. Pay by credit card or debit card. Complete the bottom portion of the payment coupon on your Medicare bill, and sign it. You’ll need to provide the account information as it appears on your card and the expiration date. Most credit cards today only have the month and year in expiration date field. If your credit card only has a month and year in the expiration date, fill in the month and year on the payment coupon and leave the boxes for the day field blank. Mail your payment to the address above.
Source: medicare.gov

Medicare Supplemental Insurance Springfield

We are driven by our customers, and passionate about providing them with a Medicare insurance plan that will work for them when they need it most. With over 14 years of experience, we understand the industry, and our commitment to you doesn’t stop with you purchasing a Medicare product. We reevaluate your case on an annual basis so that you can know that you always have a competitive product that fits your life and your needs. Life changes—your Medicare insurance plan should be able to change with it. We’ll discuss all of your options one-on-one, and identify the right plan – whether that’s a Medicare supplemental insurance plan, Medicare Advantage plan, or Medicare Part-D plan. So,
Source: 417medicare.com

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

Health Insurance Plans for Individuals & Families, Employers, Medicare

UnitedHealthcare offers health insurance plans to meet the needs of individuals and employers. Plus we offer dental, vision and many other insurance plans to help keep you and your family healthy. 
Source: uhc.com

What’s Medicare Supplement Insurance (Medigap)?

Posted by:  :  Category: Medicare

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.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: What Are Medigap Plans?

If you are going to buy a Medigap plan, the open enrollment period is six months from the first day of the month of your 65th birthday — as long as you are also signed up for Medicare Part B — or within six months of signing up for Medicare Part B. During this time, you can buy any Medigap policy at the same price a person in good health pays. If you try to buy a Medigap policy outside this window, there is no guarantee that you’ll be able to get coverage. If you do get covered, your rates might be higher.
Source: webmd.com

Medigap (Medicare Supplement Health Insurance)

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

Compare Medigap Insurance Plans

Enter your ZIP code to compare quotes from top insurance companies on Medigap.com. Prices vary from company to company, so shop around for the best prices. Medicare supplement insurance is available in up to 10 standardized insurance plans. Each plan is named with a letter of the alphabet. In Massachusetts, Minnesota and Wisconsin there are different standardized plan options available.
Source: medigap.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: What Are Medigap Plans?

However, you may have to wait up to six months for coverage if you have a pre-existing health condition. The insurer through which you buy your Medigap policy can refuse to cover out-of-pocket costs during that period. After six months, the Medigap policy must cover the pre-existing condition. The exception to this rule is if you buy a Medigap policy during your open enrollment period and have had continuous “creditable coverage,” or a health insurance policy for the six months before buying a policy. The Medigap insurance company cannot withhold coverage for a pre-existing condition in that case.
Source: webmd.com

Excellus Medicare Insurance Plans

Posted by:  :  Category: Medicare

Medigap plans, also known as Medicare Supplement Insurance, provide a way for you to supplement Parts A and B (Original Medicare), which is the insurance that pays for stays in a hospital, skilled nursing home care, visiting your doctor, lab tests, and other expenses. Excellus offers six Medicare Supplement Insurance (Medigap) plans that cover coinsurance payments, deductibles, skilled nursing coinsurance amounts, and other expenses, including those for medical expenses incurred outside of the United States.
Source: medicaresolutions.com

Excellus BlueCross BlueShield Medicare Insurance Plans

Copyright © 2016, Excellus BlueCross BlueShield, a nonprofit independent licensee of the Blue Cross Blue Shield Association. All rights reserved. View our Privacy Policy for information on how we protect your privacy. Use of this site indicates your acceptance of our Terms of Use. Follow this link to view our 31 county New York State service area. You will need Internet Explorer or Firefox to use the secure features of this site.
Source: excellusmedicare.com

Medicare Plans for Retirees

We offer a variety of plans for your retirees with comprehensive benefits, a vast network of providers and Medicare-dedicated customer service representatives. Learn more about eligibility, enrollment, billing and more with our Medicare Group Administrative Manual.
Source: excellus.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

Summary of Key Changes to Medicare in 2010 Health Reform Law   

This brief provides a detailed look at the improvements in Medicare benefits, changes to payments for providers and Medicare Advantage plans, various demonstration projects and other Medicare provisions in the law. It includes a timeline of key dates for implementing the Medicare-related provisions in the law.
Source: kff.org

Changes to Medicare With the Affordable Care Act

You can get most screening services without additional cost. Screenings are medical tests to find illnesses early, when they’re easier to treat. For instance, a mammogram is a screening for breast cancer. A colonoscopy checks for colon cancer. You can also be checked for diabetes, high blood pressure, and high cholesterol.
Source: webmd.com

MedSuppForAgents.com offers agents the resources and information they need to sell more Medicare Supplement Insurance!

This self-help web site provides insurance agents with 24-hour access to Medicare Supplement product information. Just click on one of the carriers above to view key information such as rates, plans available, contracts, underwriting rules, lead programs and more. Call us at 1-877-888-9996 and speak with one of our experienced and licensed Marketing Coordinators. Over the years, MedSuppForAgents.com has earned a reputation for integrity, leadership and performance with insurance companies, producers and consumers.
Source: medsuppforagents.com

2010 Medicare payment changes: Questions and answers

What does the new rule mean for me and what can I expect in 2010? CMS will begin to implement the changes to practice expense values for services provided on or after January 1, 2010. While the rule proposed by CMS last summer planned to reduce Medicare payments for psychological services by an average of 7 percent, the final rule will phase in reductions over four years — resulting in a lesser immediate impact of an average of 2 percent for services in 2010. Medicare payments are expected to be reduced by 2 percent on average in 2011, 2012 and 2013 as well — resulting in a total reduction of 8 percent when fully phased in. The average impact on psychological services increased from 7 to 8 percent because CMS adjusted its formula so that indirect costs represent a higher proportion of the final payment. Further, to maintain budget neutrality as required for Medicare, the higher reduction in payment for psychological services resulted from other services having increases in practice expenses.
Source: apapracticecentral.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 Information, Help, and Plan Enrollment

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

2011 Medicare Part D Program Compared to 2010, 2009, 2008 and 2007

Pharmaceutical manufacturers will be required to provide certain beneficiaries access to discount prices for certain brand drugs purchased under Medicare Part D. The manufacturer discount prices will be equal to 50% of the plan’s negotiated price defined (minus any applicable dispensing fees). These discount prices must be applied prior to any prescription drug coverage or financial assistance provided under other health benefit plans or programs and after any supplemental benefits provided under the Part D plan. The discounted prices will be charged at the pharmacy (point-of-sale). The beneficiary will not have to do additional paperwork, etc. to receive the benefit. These manufacturer discount prices will be made available to Part D enrollees who are in the coverage gap or donut hole (they have reached or exceeded the initial coverage limit and have incurred costs below the annual out-of-pocket threshold). Medicare beneficiaries will not be eligible to receive these discount prices if they are enrolled in a qualified retiree prescription drug plan or are eligible for the low-income subsidy. The costs paid by manufacturers towards the negotiated prices of drugs covered under this manufacturer discount program shall be considered incurred costs for eligible beneficiaries and applied towards their out-of-pocket threshold. This means that the total negotiated retail drug price will be applied to the TrOOP and will count toward getting out of the doughnut hole.
Source: q1medicare.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

National Government Services

National Government Services is one of the few organizations in the federal health care market that has true roots in health care and a history of delivering solutions that solve complex challenges. Our capabilities are designed to be flexible, scalable, and most importantly the right fit to meet our customers’ demands.
Source: ngsservices.com

National Genealogical Society

Genetic Genealogy in Practice, the first workbook on genetic genealogy, the book provides family historians and genealogists who have just begun to explore genetic genealogy practical, easy to understand information that they can apply to their research. Learn More.
Source: ngsgenealogy.org