Original Medicare (Part A and B) Eligibility and Enrollment

Posted by:  :  Category: Medicare

To be eligible for premium-free Part A, an individual must be entitled to receive Medicare based on their own earnings or those of a spouse, parent, or child. To receive premium-free Part A, the worker must have a specified number of quarters of coverage (QCs) and file an application for Social Security or Railroad Retirement Board (RRB) benefits. The exact number of QCs required is dependent on whether the person is filing for Part A on the basis of age, disability, or End Stage Renal Disease (ESRD). QCs are earned through payment of payroll taxes under the Federal Insurance Contributions Act (FICA) during the person’s working years. Most individuals pay the full FICA tax so the QCs they earn can be used to meet the requirements for both monthly Social Security benefits and premium-free Part A.
Source: cms.gov

Medicare Eligibility and Enrollment

re already getting Social Security checks, you will be automatically enrolled in traditional Medicare. You’ll get your Medicare card three months before your 65th birthday. The benefits kick in on the first day of the month of your 65th birthday. Traditional Medicare, which is also called original Medicare, includes Medicare Parts A and B. Part A is hospital coverage. Part B covers doctor visits, lab tests, and other outpatient services.
Source: webmd.com

Who is eligible for Medicare Part A coverage?

People over 65 who are not eligible for free Medicare Part A coverage can enroll in it and pay a monthly fee for the same coverage. The premium base rate depends on the number of work credits you’ve earned. If you pay for Part A hospital insurance, you must also enroll in Part B medical insurance, for which you pay an additional monthly premium. Note that the Medicare Part A premium increases by 10% for each year after your 65th birthday that you wait to enroll.
Source: nolo.com

Am I eligible for Medicare if I am under 65?

Note that Social Security, not Medicare, makes the determination of whether you qualify for SSDI checks. In addition, the Social Security Disability Insurance program administers these checks as long as you or your family members have worked long enough and paid Social Security taxes. For more information on the Social Security Disability Insurance program, it’s best to contact your local Social Security Administration office.
Source: medicareinteractive.org

Medicare and Medicaid: What's the Difference?

Costs to Consumer: You must pay a yearly deductible for both Medicare Part A and Part B, and make hefty copayments for extended hospital stays. Under Part B, you must pay the 20% of doctors’ bills Medicare does not pay, and sometimes up to 15% more. Part B also charges a monthly premium. Under Part D, you must pay a monthly premium, a deductible, copayments, and all of your prescription drug costs over a certain yearly amount and up to a ceiling amount, unless you qualify for a low-income subsidy.
Source: nolo.com

Who is eligible?: Medicaid: Medical Services: Services: Department of Human Services: State of North Dakota

You must be a United States citizen or an alien who is lawfully admitted for permanent residence. Some lawfully admitted aliens who were admitted to the United States after August 22, 1996, may have to wait for five years before full Medicaid benefits are available. After the five years, aliens who are lawfully admitted, who are credited with 40 qualifying quarters of social security coverage, may be eligible for Medicaid.
Source: nd.gov

Medicare Eligibility Requirements

Part C: Medicare Part C is the Medical Advantage Plan whose services are performed by private companies also approved by Medicare. Part C combines Part A and Part B and may include coverage for other necessary medical services (drug prescription, hearing, and vision services). You must have Medicare Part A and Part B to be eligible for a Part C plan.  Many people will opt for this plan because it offers the ability to add a wide range of service coverage to their medical insurance plan.  However, most Medicare Advantage Plans consist of particular doctors and hospitals in an area that a person must use in order to receive coverage for the medical treatment they receive. In addition to the premium paid for Part B Medicare coverage, a person receiving Part C coverage will have to pay a monthly premium.  Benefits, premiums, and/or member cost-share may change on January 1 of each year. You must continue to pay your Medicare Part B premium.  There are several Medicare Advantage Plans available to you.  These plans include Medicare Health Maintenance Organizations (HMO), Medicare Preferred Provider Organization plans (PPO), Medicare Private Fee-for-Service plans (PPFS), Medicare Special Needs, and Medicare Medical Savings Account (MSA).  You must have Parts A and B to be eligible for a Medicare Advantage Plan.
Source: medicaresolutions.com

Who is Eligible for Medicare?

Your eligibility for Medicare is based on your age and your medical condition. If you’re eligible, you can usually sign up for Medicare Part A — hospital care and similar expenses — without paying a premium, based on the years you or your spouse have been working and paying Medicare taxes. If you haven’t put in enough work, the premium, at time of writing, was $407 a year. Part B, which covers doctor visits and other services, costs $104.90 a month, though some high-income individuals pay more.
Source: ehow.com

Who Is Eligible for Medicare Part B?

Medicare is a federal insurance program that provides for hospital care, medical care, and prescription drug benefits. It can be difficult to understand how eligibility is determined for the various Medicare plans as they do have set rules and eligibility requirements. Adding to the confusion is the fact that while it is the Social Security Administration that determines the eligibility for Medicare, the plan itself is actually administered by the Centers for Medicare and Medicaid Services (CMS). This article will help you in determining whether or not you qualify for Medicare Part B.
Source: seniorcorps.org

Medicare Part D Eligibility

You also must be enrolled in one of the other branches before you can be considered for Medicare Part D eligibility. The other three branches offer different medical coverage for the wide range of medical expenses. Each branch is specialized and will take care of the patient’s expenses with little to no cost to the individual. If you have a working knowledge of these branches, you can get a better idea of what your coverage will pay for, as well as if you are ready to be considered for Medicare Part D eligibility. For eligibility to be enrolled in one of the other branches, you should at least know what the scope of the different branches are.
Source: medicarepartd.org

Eligibility for Medicare Supplement (Medigap) Plans

Trial rights allow you to join a Medicare Advantage plan for a one-year trial period if you are enrolling in Medicare Part C for the first time. If you’re not happy with the plan, you can return to Original Medicare anytime within the first 12 months. Then, if you dropped a Medicare Supplement plan to enroll in your Medicare Advantage plan, you can apply for the same Medicare Supplement policy you had previously if it’s still offered by the insurance company you were with before. If your former Medicare Supplement plan is no longer available, you have a special trial right to enroll in any Plan A, B, C, F, K, or L that is offered by any insurance company in your state. You may want to have your new Medicare Supplement policy go into effect at the same time your Medicare Advantage coverage ends to avoid breaks in your coverage. You can apply as early as 60 days before your Medicare Advantage coverage ends and no later than 63 days after your plan coverage ends.
Source: medicare.com

Kentucky: Cabinet for Health and Family Services

Kentucky Medicaid provides partial financial assistance with Medicare premiums, deductibles, or coinsurance – through the Medicare Savings Program (i.e., Qualified Medicare Beneficiaries, Specified Low-Income Medicare Beneficiaries, and Qualifying Individuals) – to certain low income Medicare beneficiaries who are not entitled to the full Medicaid benefit package.
Source: ky.gov

What is Medicare? What is Medicaid?

Medicare Part A, or Hospital Insurance (HI), helps pay for hospital stays, which includes meals, supplies, testing, and a semi-private room. This part also pays for home health care such as physical, occupational, and speech therapy that is provided on a part-time basis and deemed medically necessary. Care in a skilled nursing facility as well as certain medical equipment for the aged and disabled such as walkers and wheelchairs are also covered by Part A. Part A is generally available without having to pay a monthly premium since payroll taxes are used to cover these costs.
Source: medicalnewstoday.com

Medigap Insurance Eligibility

If you’re enrolled in a Medicare Part C Medicare Advantage plan but move outside that plan’s service area, the plan doesn’t have to continue covering you. You’ll need to look for a new managed care plan that serves the area where you now lives, or you can return to traditional Medicare Part A and Part B. If you do return to traditional Medicare Part A and Part B, you’re guaranteed the right to buy any Plan A, B, C, or F medigap policy offered in the state where you now live. You can buy any one of these policies without any medical screening, regardless of your medical history, and for the same premium as anyone else your age who bought the same policy at age 65.
Source: caring.com

Who is eligible for Medicare

You can get Medicare Part A, or hospital insurance, with no monthly premium if you or your spouse have worked and paid Medicare taxes for at least 10 years. If you don’t qualify to get Part A for free, you can still get it by paying a monthly premium. 
Source: bcbsm.com

Medicare Eligibility Requirements

By law, you’re allowed to sign up for any Medigap policy in your state as long as you enroll during the initial window, even if you have medical issues that would otherwise prevent you from getting covered. An insurer has to charge you the same premium rate as a healthy person, too, so enrolling during this initial period is essential if you need the extra coverage. Your guarantees under the initial enrollment window expire once that 6-month eligibility period ends. Outside of the initial eligibility window, you may not find Medigap coverage at all. And if you do, it will probably cost a lot more.
Source: medicare.net

Raising the Age of Eligibility for Medicare to 67: An Updated Estimate of the Budgetary Effects

Outlays for Medicare would be lower under this option because fewer people would be eligible for the program than the number projected under current law. In addition, outlays for Social Security retirement benefits would decline slightly because raising the eligibility age for Medicare would induce some people to delay applying for retirement benefits. One reason is that some people apply for Social Security at the same time that they apply for Medicare; another reason is that this option would encourage some people to postpone retirement to maintain their employment-based health insurance coverage until they became eligible for Medicare. CBO expects that latter effect would be fairly small, however, because of two considerations: First, the proportion of people who currently leave the labor force at age 65 is only slightly larger than the proportion who leave at slightly younger or older ages, which suggests that maintaining employment-based coverage until the eligibility age for Medicare is not the determining factor in most people’s retirement decisions. Second, with the opening of the health insurance exchanges, workers who give up employment-based insurance by retiring will have access to an alternative source of coverage (and may qualify for subsidies if they are not eligible for Medicare). This option could also prompt more people to apply for Social Security disability benefits so they could qualify for Medicare before reaching the usual age of eligibility. However, in CBO’s view, that effect would be quite small, and it is not included in this estimate.
Source: cbo.gov

Who Is Eligible for Medicare?

The $15,978 Social Security bonus most retirees completely overlook If you’re like most Americans, you’re a few years (or more) behind on your retirement savings. But a handful of little-known “Social Security secrets” could help ensure a boost in your retirement income. In fact, one MarketWatch reporter argues that if more Americans knew about this, the government would have to shell out an extra $10 billion annually. For example: one easy, 17-minute trick could pay you as much as $15,978 more… each year! Once you learn how to take advantage of all these loopholes, we think you could retire confidently with the peace of mind we’re all after. Simply click here to discover how you can take advantage of these strategies.
Source: mysanantonio.com

What Does Dual Eligible Mean?

Plans often called "dual" or "dual eligible" are designed for people who qualify for both Medicare and Medicaid at the same time. These plans include all Medicare Part A (hospital stay) and Part B (doctor visit) benefits and Part D prescription drug coverage. For people with limited incomes, these plans may offer better health care coverage than Original Medicare and a separate Part D plan.
Source: uhcmedicaresolutions.com

Marketplace Eligibility for Health Insurance Coverage

U.S. citizens living in a foreign country for at least 330 days of a 12-month period are not required to get health insurance coverage for that 12-month period. If you’re uninsured and living abroad under this definition, you qualify for a health insurance exemption. This means you don’t have to pay the fee that other uninsured people must pay.
Source: healthcare.gov

Medicare Eligibility Requirements

If you’re turning 65, you have an opportunity to enroll in Medicare. You can enroll three months before the month you turn 65, the month of your birthday or three months after your birth month. Eligibility requirements include:
Source: aarpmedicaresupplement.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

Find and Compare Best Medicare Plans Online

The Original Medicare Plan, or Part A and Part B coverage, is a federally managed fee-for-service plan. Beneficiaries can choose the doctor and hospital from which they would like to receive services. Monthly premiums, annual deductibles and co-payments for services are required. Prescription drug coverage, or Medicare Part D, may be added to the Original Medicare Plan. Many beneficiaries covered by the Original Medicare Plan find they also need the Medigap policy to help pay for services not covered by Part A and Part B. Medicare Advantage Plans (Part C) provides Part A and Part B coverage, but this coverage is provided by private insurance companies that have been approved by Medicare. Because private companies provide this coverage, additional benefits may be available. Additionally, the amounts charged for various services may differ between providers. Part C plans may have networks, and the beneficiary will have to utilize the services of providers in the plan’s network. Prescription drug coverage is often included in this plan. Beneficiaries of Medicare Part C do not need to purchase Medigap coverage. When choosing a plan it is important to determine what is expected from the insurance coverage. It would be advantageous for beneficiaries to compare and select coverage based on the plan that will best meet their individual needs.
Source: online-health-insurance.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

Medicare News and Information

Posted by:  :  Category: Medicare

If you are approaching Medicare eligibility, or are already eligible, you know that figuring out your Medicare coverage options can be challenging. There are so many choices. How can you compare options and find the one that truly meets your needs?
Source: medicare.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

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 2016 & 2017 costs at a glance

The standard Part B premium amount in 2017 will be $134 (or higher depending on your income). However, most people who get Social Security benefits will pay less than this amount. This is because the Part B premium increased more than the cost-of-living increase for 2017 Social Security benefits. If you pay your Part B premium through your monthly Social Security benefit, you’ll pay less ($109 on average). Social Security will tell you the exact amount you will pay for Part B in 2017. You’ll pay the standard premium amount if:
Source: medicare.gov

Medicare Part D Costs & Coverage

After you reach your yearly deductible, you may still be responsible for certain out-of-pocket costs, even after your Medicare plan has covered its share. This may include coinsurance and copayments. If you have to pay a coinsurance, you will be responsible for a percentage of the cost of the drug. For example, you may owe a 15% coinsurance each time you fill a particular prescription. If you have to pay a copayment, you will be responsible for paying a set amount for medications on a certain tier as determined by your Medicare plan. As mentioned, Medicare plans that cover prescription drugs place covered drugs into cost tiers, and medications on higher tiers may have higher copayments and coinsurance costs. Your cost sharing may also vary depending on whether you’re taking brand-name or generic medications; generics tend to have lower costs than brand-name prescription drugs.
Source: ehealthinsurance.com

How much does Medicare Part D cost?

Part D premiums range from $10-$100 per month (depending on the plans available in your area and on the partiular plan you choose). The maximum deductible — the amount you must pay out-of-pocket before Medicare will contribute to your prescription costs — in 2016 is $360. After you meet the deductible, Medicare will pay roughly 75% of your prescription costs.
Source: nolo.com

Compare Medicare Part D Prescription Drug Plans

Keep in mind that just as costs can vary by plan, Medicare plans that include prescription drug coverage may also vary when it comes to the specific prescription drugs they cover. An easy way to make sure that your current medications are covered is to check the plan’s formulary (list of covered medications) before enrolling in a Medicare plan that includes prescription drug coverage. Keep in mind that formularies are subject to change. Your Medicare Prescription Drug Plan or Medicare Advantage Prescription Drug plan will notify you if necessary.
Source: ehealthinsurance.com

Out of Pocket Costs for Medicare Part D in 2016

Once you are in the donut hole, you will pay 45 percent for brand name medications and 58 percent for generic medications, not your usual copays. This tends to cause a sharp increase in your out of pocket spending. You will pay smaller percentages each year through 2020.
Source: verywell.com

The United States Social Security Administration

Posted by:  :  Category: Medicare

We have all received gifts we’ve wanted to return: ugly socks or sweaters that look exactly like the one you got (or gave!) last year. Sometimes, just letting loved ones know that you’re there for them, no matter what, is the best gift of all…
Source: ssa.gov

SocialSecurity.gov/SSA.gov: The Official Site of the U.S. Social Security Administration

SocialSecurity.gov (or ssa.gov ) is the official website of the U.S. Social Security Administration. Most of the management of your retirement, disability, and government health benefits can be done right on the SocialSecurity.gov website. SocialSecurity.gov contains a wealth of information, so it can give beneficiaries a better idea of what they qualify for, how to apply for benefits, and what benefits they will receive.
Source: ehealthmedicare.com

County of Sonoma, California

The California Department of Public Health (CDPH) is warning recreational anglers not to consume the viscera (internal organs) of Dungeness crab caught in coastal waters north of Point Reyes, California. This warning is due to the sporadic detection of elevated levels of domoic acid in the viscera of Dungeness crabs caught off the Northern California coast.
Source: ca.gov

Social Security Administration

For some claimants, this program is harder to receive than funds from RSDI. To warrant a processing time of anything more than a day and an immediate denial, certain specific criteria must be met, including citizenship status, having less than $2,000.00 in countable financial resources, or having countable income of less than $718.00 per month from any source. Disposal of a financial resource (i.e., a deliberate spend-down to fall under SSI resource ceilings) can prevent a person from receiving SSI benefits for a period up to 36 months. Every person with or without a Social Security Number is eligible to apply. But if a person does not meet any of the above criteria or is not a documented resident of the United States, his or her claim can only be taken on paper and will be immediately denied. Even documented residents with legal permanent resident status after August 1996 are immediately denied unless they meet some or all of the SSI criteria listed above.
Source: wikipedia.org

Apply for Social Security Disability in California

California is home to over 100 Social Security field offices and a number of offices of Disability Determination Services and Offices of Disability Adjudication and Review. Any of these offices can be contacted with any questions you may have regarding your Social Security Disability application.
Source: disability-benefits-help.org

Medicare Advantage 2015 Data Spotlight: Overview of Plan Changes

Posted by:  :  Category: Medicare

When SNPs were authorized, there were few requirements beyond those otherwise required of other Medicare Advantage plans. The Medicare Improvements for Patients and Providers Act (MIPPA) of 2008 established additional requirements for SNPs, including requiring all SNPs to provide a care management plan to document how care would be provided for enrollees and requiring C-SNPs to limit enrollment to beneficiaries with specific diagnoses or conditions. As a result of the new MIPPA requirements, the number of SNPs declined in 2010. The ACA required D-SNPs to have a contract with the Medicaid agency for every state in which the plan operates, beginning in 2013. Additionally, in 2013, joint federal-state financial alignment demonstrations to improve the coordination of Medicare and Medicaid for dually eligible beneficiaries began to enroll beneficiaries. Today, financial alignment demonstrations are underway in 12 states: California, Colorado, Illinois, Massachusetts, Michigan, Minnesota, New York, Ohio, South Carolina, Texas, Virginia, and Washington. The financial alignment demonstrations could influence the availability of D-SNPs in these states, either increasing or decreasing the availability of SNPs, depending on the design of the demonstration.
Source: kff.org

Changes to Medicare insurance 2013

Seniors with Medicare do not have to purchase any other type of health insurance. Medicare is a recognized health insurance under the Affordable Care Act. If you have Medicare then you are in compliance. This groundless story came about from the Mandate. However, time the Exchanges open overlaps with Medicare open enrollment. Medicare policy owners may switch from traditional Medicare-to-Medicare Advantage and have the right to change their prescription coverage plans. However, the Exchanges do not deal with any Medicare changes. And there is no requirement for Medicare insured to make any changes.
Source: obamacarefacts.com

Quarterly PTP and MUE Version Update Changes

With the October 1, 2011 PTP and MUE quarterly version updates, CMS is now posting the changes to each of its National Correct Coding Initiative Procedure-to-Procedure (PTP) and Medically Unlikely Edit (MUE) published edit files on a quarterly basis. The additions, deletions, and revisions to published MUEs for Practitioner Services, Outpatient Hospital Services, and DME Supplier Services, the additions, deletions, and modifier indicator quarterly changes to PTP column 1/ column 2 correct coding edits and the PTP mutually exclusive code edits for Practitioners, and the additions, deletions, and modifier indicator quarterly changes to PTP column 1/ column 2 correct coding edits and the PTP mutually exclusive code edits for Hospital Outpatient PPS in the Outpatient Code Editor are on this page under downloads. These changes reflect the modifications in the PTP and MUE published edit files posted for the current quarter.
Source: cms.gov

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

Medigap Enrollment Among New Medicare Beneficiaries: How Many 65

Jacobson G., Neuman P., and Damico A. 2015. “At Least Half of All Medicare Advantage Enrollees Had Switched From Traditional Medicare, 2006–11.” Health Affairs. 34(1): 48–55.  Hoadley, J., Hargrave, E., Summer, L., et al. 2013. “To Switch or Not to Switch: Are Medicare Beneficiaries Switching Drug Plans to Save Money?” Kaiser Family Foundation, October 2013. Abaluck, J. and Gruber, J. 2013. “Evolving Choice Inconsistencies in Choice of Prescription Drug Insurance,” NBER Working Paper No. 19163, June 2013.  Abaluck, J. and Gruber, J. 2011. “Choice Inconsistencies Among the Elderly:  Evidence from Plan Choice in the Medicare Part D Program.” American Economic Review, 101(4): 1180-1210. Heiss, F., Leive, A., McFadden D., and Winter, J. 2012. “Plan Selection in Medicare Part D: Evidence from Administrative data,” NBER Working Paper No. 18166, June 2012. Zhou C. and Zhang, Y. 2012. “The Vast Majority of Medicare Part D Beneficiaries Still Don’t Choose the Cheapest Plans That Meet Their Medication Needs.” Health Affairs. 31(1): 2259-2265. Said, Q., King, A. J., Erickson, S. W., et al. 2015. “Self-Reported Plan Switching in Medicare Part D: 2006-2010.” American Journal of Pharmaceutical Benefits 6(6): e157-168. Ketcham, J. D., Lucarelli, C., and Powers, C. A. 2015. “Paying Attention Or Paying Too Much in Medicare Part D.” American Economic Review, 105(1): 204-33.
Source: kff.org

Medicare Advantage Drug Formulary

Posted by:  :  Category: Medicare

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 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

Texas Medicaid/CHIP Vendor Drug Program: Formulary Information

The Enhanced Formulary Search identifies Medicaid formulary drugs and criteria used to evaluate a prior authorization for a specific drug and the alternate therapies (where applicable) that are allowed. The Texas Medicaid formulary and Preferred Drug List are available on the Epocrates drug information system.
Source: txvendordrug.com

Medicare coverage of hospice care

Posted by:  :  Category: Medicare

. The third benefit period begins on day 180 of hospice. After that, you must continue to have face-to-face meetings with a hospice doctor or nurse practitioner before the start of each following 60-day benefit period. The meeting must take place no earlier than 30 days before the new benefit period to confirm you still qualify for hospice care.
Source: medicareinteractive.org

Medicare & Cost of Hospice

VITAS hospice patients who meet those qualifications will have their hospice care covered by Medicare. For care unrelated to a patient’s terminal illness, Medicare and Medicaid continue to provide their usual benefits. Since each private insurance company has its own policies regarding hospice coverage, VITAS can contact the patient’s insurer to ask about coverage provided. However, VITAS is committed to admitting and caring for all hospice-appropriate patients who are referred to us, regardless of their insurance coverage or ability to pay.
Source: vitas.com

Welcome to Arkansas Medicaid

Posted by:  :  Category: Medicare

The Arkansas Department of Human Services (DHS), Division of Medical Services (DMS) is providing public notice of its intent to submit to the Centers of Medicare and Medicaid Services (CMS) a written application for extension and amendment of the 1115 Demonstration waiver for the Health Care Independence Program and to hold public hearings to receive comments on the extension application to the Demonstration Waiver. The State anticipates submitting an application to amend the Demonstration in fall of 2016 to replace the Health Care Independence Program implemented under the current 1115 waiver authority with Arkansas Works, a program reflecting the features now under consideration by the Governor, the Arkansas Legislative Task Force on Healthcare Reform, and the Arkansas Legislature.
Source: ar.us

Arkansas Medicaid Program

Medicaid provides health coverage to millions of Americans, including children, pregnant women, parents, seniors and individuals with disabilities.  In some states the program covers all low-income adults below a certain income level.
Source: benefits.gov

Welcome to Arkansas Medicaid

Use of this application is restricted to authorized users. User activity is monitored and recorded by system personnel. Anyone using this application expressly consents to such monitoring and recording. BE ADVISED: if possible criminal activity is detected, system records, along with certain personal information, may be provided to law enforcement officials.
Source: ar.us