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.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 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 medications on your plan’s formulary, or list of covered drugs, will count toward your out-of-pocket costs and help you get out of the coverage gap* 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 prescription drugs from a participating pharmacy, make sure you do so, or else the costs may not apply towards getting out of the coverage gap. 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

The Coverage Gap: Uninsured Poor Adults in States that Do Not Expand Medicaid

State decisions about Medicaid expansion have implications for the potential scope of Medicaid under the ACA. If all states expanded their Medicaid programs, eligibility for Medicaid in non-expansion states would grow from less than half a million to 4.5 million. Though some of these people can currently purchase subsidized coverage through the Marketplace, there are advantages and disadvantages to Medicaid and private coverage in different states. For example, enrollees may face higher out-of-pocket costs and limited networks for Marketplace coverage than they would for Medicaid, whereas access to specialist care may be problematic in some state Medicaid programs. In addition, while people can enroll in Medicaid throughout the year, Marketplace enrollment is only available during a limited open enrollment period. Medicaid is designed to provide a safety net of coverage for low-income people, with benefits and provider networks targeted to this population and coverage available throughout the year as people’s circumstances change. There is no deadline for states to opt to expand Medicaid under the ACA, and debate continues in some states about whether to expand. If more states adopt the expansion, the coverage gap will shrink and more low-income adults will gain access to Medicaid eligibility.
Source: kff.org

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

Part D Information for Pharmaceutical Manufacturers

The Medicare Coverage Gap Discount Program (Discount Program) makes manufacturer discounts available to eligible Medicare beneficiaries receiving applicable, covered Part D drugs, while in the coverage gap. In order to participate in the Discount Program, manufacturers must sign an agreement with CMS to provide the discount on all of its applicable drugs (i.e. prescription drugs approved or licensed under new drug applications or biologic license applications). Beginning in 2011, only those applicable drugs that are covered under a signed manufacturer agreement with CMS can be covered under Part D.
Source: cms.gov

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

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

Prescription Drug Coverage

Posted by:  :  Category: Medicare

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

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 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.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

Annual Statistical Supplement, 2011

Beginning January 1, 2006, upon voluntary enrollment in either a stand-alone PDP or an integrated Medicare Advantage plan that offers Part D coverage in its benefit, subsidized prescription drug coverage. Most FDA-approved drugs and biologicals are covered. However, plans may set up formularies for their drug coverage, subject to certain statutory standards. (Drugs currently covered in Parts A and B remain covered there.) Part D coverage can consist of either standard coverage or an alternative design that provides the same actuarial value. (For an additional premium, plans may also offer supplemental coverage exceeding the value of basic coverage.) Standard Part D coverage is defined for 2006 as having a $250 deductible, with 25 percent coinsurance (or other actuarially equivalent amounts) for drug costs above the deductible and below the initial coverage limit of $2,250. The beneficiary is then responsible for all costs until the $3,600 out-of-pocket limit (which is equivalent to total drug costs of $5,100) is reached. For higher costs, there is catastrophic coverage; it requires enrollees to pay the greater of 5 percent coinsurance or a small copay ($2 for generic or preferred multisource brand and $5 for other drugs). After 2006, these benefit parameters are indexed to the growth in per capita Part D spending (see Table 2.C1). In determining out-of-pocket costs, only those amounts actually paid by the enrollee or another individual (and not reimbursed through insurance) are counted; the exception is cost-sharing assistance from Medicare’s low-income subsidies (certain beneficiaries with low incomes and modest assets will be eligible for certain subsidies that eliminate or reduce their Part D premiums, cost-sharing, or both) and from State Pharmacy Assistance Programs. A beneficiary premium, representing 25.5 percent of the cost of basic coverage on average, is required (except for certain low-income beneficiaries, as previously mentioned, who may pay a reduced or no premium). For PDPs and the drug portion of Medicare Advantage plans, the premium will be determined by a bid process; each plan’s premium will be 25.5 percent of the national weighted average plus or minus the difference between the plan’s bid and the average. To help them gain experience with the Medicare population, plans will be protected by a system of risk corridors, which allow Part D to assist with unexpected costs and to share in unexpected savings; after 2007, the risk corridors became less protective. To encourage employer and union plans to continue prescription drug coverage to Medicare retirees, subsidies to these plans are authorized; the plan must meet or exceed the value of standard Part D coverage, and the subsidy pays 28 percent of the allowable costs associated with enrollee prescription drug costs between a specified cost threshold ($250 in 2006, indexed thereafter) and a specified cost limit ($5,000 in 2006, indexed thereafter).
Source: ssa.gov

2011 Medicare Cost Sharing Details 

Standard Part B Premium: In addition to the two "hold harmless" Part B premium amounts, there will be a standard Part B premium amount of $115.40 for 2011. Individuals who are new to Medicare in 2011 or who did not have Medicare premiums withheld from their Social Security or their Railroad Retirement checks in 2010 will pay $115.40. Individuals who currently have their Part B premiums paid for by the Qualified Individual (QI) program[3] are in jeopardy of having to pay the $115.40 Part B premium in 2011 if Congress does not extend the QI program beyond the end of the year. That is because their Part B premiums were not withheld from their Social Security checks during the requisite time periods to be eligible for the hold harmless protection. Their premiums were paid for by their state under the QI program. People who lose eligibility for one of the other Medicare Savings Programs, Qualified Medicare Beneficiary (QMB) and Specified Low-Income Medicare Beneficiary (SLMB), will also have to pay the $115.40 Part B premium.
Source: medicareadvocacy.org

2011 Medicare Hospital Cost Reports

All hospitals in Illinois, those hospitals in contiguous states providing 100 or more paid acute inpatient days of care to Illinois Medicaid Program participants, and all hospitals located in states contiguous to Illinois that elect to be reimbursed under the methodology described in 89 Ill. Adm. Code 149 (the Diagnosis Related Grouping (DRG) Prospective Payment System (PPS)), shall be required to file Medicaid and Medicare cost reports within 150 days after the close of that provider’s fiscal year.
Source: illinois.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

Medicare Advantage Oregon

Oregon is considered one of the leading states for healthcare, particularly for seniors. It ranks among the highest for long-term care services. And, certain provisions that began on Jan. 1, 2016, expand insurance coverage, including that for prescription medicines. Despite these changes, Oregon has some of the nation’s lowest healthcare costs.
Source: medicare.net

Oregon Consumer Assistance

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

Medicare Health Plans, Coverage And Online Enrollment

Posted by:  :  Category: Medicare

*Plan performance summary star ratings are assessed each year and may change from one year to the next. (Centers for Medicare & Medicaid Services Health Plan Management System, Plan Ratings 2012. Kaiser Permanente contract #H0524, #H0630, #H1170, #H1230, #H2150, #H6360, #H9003). This page was last updated: October 1, 2012 at 12 a.m. PT
Source: kaiserpermanente.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

Things to know about Medicare Advantage Plans

Medicare Advantage Plans have a yearly limit on your out-of-pocket costs for medical services. Once you reach this limit, you’ll pay nothing for covered services. This limit may be different between Medicare Advantage Plans and can change each year. You should consider this when choosing a plan.
Source: medicare.gov

Kaiser Permanente Advantage Plus

• If you are already a Senior Advantage member, you may add Advantage Plus during the annual election period October 15 – December 7 for coverage to become effective on January 1, 2015. If you don’t enroll during the annual election period, you have until March 31, 2015 to enroll. Coverage is effective the first day of the month following the date we receive your completed enrollment form.
Source: kaiserpermanente.org

Benefits for People with Disabilities

Posted by:  :  Category: Medicare

The Social Security and Supplemental Security Income disability programs are the largest of several Federal programs that provide assistance to people with disabilities. While these two programs are different in many ways, both are administered by the Social Security Administration and only individuals who have a disability and meet medical criteria may qualify for benefits under either program.
Source: ssa.gov

Disability Planner: Medicare Coverage If You’re Disabled

Everyone with Medicare also has access to prescription drug coverage (Part D) that helps pay for medications doctors prescribe for treatment. For more information on the enrollment periods for Part D, we recommend you read Medicare’s "How to get drug coverage" page.
Source: ssa.gov

Original Medicare (Part A and B) Eligibility and Enrollment

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 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

Does Medicare or Medicaid Come with Disability?

Do you get Medicare coverage if you were approved for SSI? Claimants who are approved for SSI only typically receive Medicaid coverage in most states. And like SSI, Medicaid is subject to income and asset limitations. Medicaid is a needs-based, state- and county-administered program that provides for a number of doctor visits and prescriptions each month, as well as nursing home care under certain conditions. Can you ever get Medicare if you get SSI? Medicare coverage for SSI recipients does not occur until an individual reaches the age of 65 if they were only entitled to receive monthly SSI disability benefits. At the age of 65, these individuals are able to file an uninsured Medicare claim, which saves the state they reside in the cost of Medicaid coverage. Basically, the state pays the medical premiums for an uninsured individual to be in Medicare so that their costs in health coverage provided through Medicaid goes down. 
Source: disabilitysecrets.com

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

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 (“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 medications on your plan’s formulary, or list of covered drugs, will count toward your out-of-pocket costs and help you get out of the coverage gap* 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 prescription drugs from a participating pharmacy, make sure you do so, or else the costs may not apply towards getting out of the coverage gap. 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

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 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

Part D Information for Pharmaceutical Manufacturers

The Medicare Coverage Gap Discount Program (Discount Program) makes manufacturer discounts available to eligible Medicare beneficiaries receiving applicable, covered Part D drugs, while in the coverage gap. In order to participate in the Discount Program, manufacturers must sign an agreement with CMS to provide the discount on all of its applicable drugs (i.e. prescription drugs approved or licensed under new drug applications or biologic license applications). Beginning in 2011, only those applicable drugs that are covered under a signed manufacturer agreement with CMS can be covered under Part D.
Source: cms.gov

The Coverage Gap: Uninsured Poor Adults in States that Do Not Expand Medicaid

State decisions about Medicaid expansion have implications for the potential scope of Medicaid under the ACA. If all states expanded their Medicaid programs, eligibility for Medicaid in non-expansion states would grow from less than half a million to 4.5 million. Though some of these people can currently purchase subsidized coverage through the Marketplace, there are advantages and disadvantages to Medicaid and private coverage in different states. For example, enrollees may face higher out-of-pocket costs and limited networks for Marketplace coverage than they would for Medicaid, whereas access to specialist care may be problematic in some state Medicaid programs. In addition, while people can enroll in Medicaid throughout the year, Marketplace enrollment is only available during a limited open enrollment period. Medicaid is designed to provide a safety net of coverage for low-income people, with benefits and provider networks targeted to this population and coverage available throughout the year as people’s circumstances change. There is no deadline for states to opt to expand Medicaid under the ACA, and debate continues in some states about whether to expand. If more states adopt the expansion, the coverage gap will shrink and more low-income adults will gain access to Medicaid eligibility.
Source: kff.org

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

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

U.S. government suspends enrollment in Cigna Medicare Advantage, drug plans

Posted by:  :  Category: Medicare

n”>The U.S. government has suspended new enrollment in Cigna Corp’s Medicare Advantage health insurance and prescription drug plans, saying Cigna had “widespread and systemic failures” that prevented patients from accessing medical services. The government said Cigna did not handle complaints and grievances properly from patients who had been denied coverage for health benefits or drugs, according to a Jan. 21 letter from its regulator, the Centers for Medicare and Medicaid.
Source: reuters.com

Humana, Cigna hit by lower 2017 Medicare star ratings

Humana and Cigna saw stock prices fall Wednesday after the CMS released its latest star ratings that showed declines in both insurers’ Medicare quality measures. The companies said the lower ratings follow a recent CMS audit that resulted in sanctions for Cigna. Overall, more Medicare Advantage programs received top quality ratings from the CMS for their 2017 plans than in previous years. The agency reported that nearly 70% of Medicare Advantage enrollees would be in plans that received at least four stars. However, the average star rating declined slightly, according to data released Wednesday. Shares of Humana fell 5% Wednesday after CMS reported that the percentage of Medicare Advantage members in Humana plans with four stars or higher fell by half, from 78% a year ago to 37%. The insurer said it would appeal the ratings and raised its full-year guidance, arguing the scores do not reflect its current business. Aetna, Humana’s partner in a huge merger currently being challenged by the U.S. Justice Department, also saw its stock prices tumble despite Aetna’s own star ratings, which grew 4 percentage points from last year. The CMS reported 91% of Aetna’s members are enrolled in four-star plans. Cigna, meanwhile, which has spent nearly a year trying to resolve problems in its Medicare Advantage plans, had only 20% of its members in plans rated four stars or higher. On Wednesday, Cigna shares fell 2.4% to $121.96. “We do not believe that these stars ratings reflect the quality offerings Cigna HealthSpring provides to beneficiaries,” the company said in a Securities and Exchange Commission filing. “We will work fully with the CMS through their process to ensure that they have the information and analysis needed to calculate final Stars ratings that more accurately reflect our performance.” The star ratings for the first time incorporated socio-economic information about plan enrollees. The change was announced after pressure from health plans and the release of studies showing patients eligible for both Medicaid and Medicare scored consistently worse than other enrollees on performance measures. A total of 208 Medicare Advantage plans with prescription drug coverage for 2017 scored four stars or higher. They have a combined enrollment of about 68% of all enrollees. That is up from 179 plans in 2016 and 158 plans in 2015. The average star rating for all 364 contracts was four. The performance of Part D standalone prescription drug plans also improved slightly. Almost half of the plans received at least four stars, representing about 41% of enrollees. Enrollment in Medicare Advantage plans next year is expected to be at an all-time high of about 18 million, which is about one-third of all Medicare enrollees, according to the CMS. Plans receive a star rating of one to five based on quality and performance measures in categories such as outcomes, patient experience and access. Plans that receive a score of four or higher receive a 5% bonus payment. Those that consistently receive less than three stars can be eliminated from the program. The CMS levied sanctions against Cigna last year. That banned the company from marketing and selling its Medicare Advantage policies to new beneficiaries. The CMS said Cigna plans “posed serious threats to the health and safety of Medicare beneficiaries.” For example, Cigna inappropriately denied medical care and prescription drugs to its members. Earlier this week, Cigna announced the retirement of Herbert Fritch, who oversees its Medicare business, Cigna-HealthSpring. Cigna faces other challenges as it, along with Anthem, which is trying to acquire Cigna, fend off an antitrust challenge. The two companies are accusing each other of breaching terms of their merger agreement, according to legal filings.
Source: modernhealthcare.com

Cigna expects Medicare Advantage decline of 50,000 customers

Cigna officials also plan to disclose preliminary expectations that shareholders’ net income for full year 2016 is projected to be in the range of $1.87 billion to $1.94 billion. They also expect to reaffirm projected full year 2016 consolidated adjusted income from operations, which remains in the range of $2.03 billion to $2.1 billion, according to the filing.
Source: hartfordbusiness.com

Cigna Medicare Insurance Plans

The Medicare Supplement Insurance (Medigap) policies offered provide a way for you to supplement your Original Medicare benefits. While Medicare Part A and B pay for certain hospital stay and physician services provided, Medigap can help you cover your costs associated with Part A and B deductibles, coinsurance, and copayment requirements. It offers seven supplemental Medicare plans with basic to comprehensive coverage for everything from deductibles to copayments, excess charge coverage, and skilled nursing facility care coinsurance costs.
Source: medicaresolutions.com

Cigna temporarily banned from new Medicare plans

“Cigna has had a longstanding history of non-compliance with CMS requirements,” the agency said. “Cigna has received numerous notices of non-compliance, warning letters, and corrective action plans from CMS over the past several years. A number of these notices were for the same violations discovered during the audit, demonstrating that Cigna has not corrected issues of non-compliance.”
Source: usatoday.com

Medicare Supplement Rates Updated Daily

Posted by:  :  Category: Medicare

Since there is large number of companies providing Medigap insurance at various rates, we suggest you shop around. The good thing is that you can use our quote engine to find all the rates from every top provider from this very site! Fill your details at the top of this page and let MedSupRates do the shopping for you; you may save a lot of money on your premiums. Since these plans are standardized, you will receive the same coverage from all the companies but the premium rates can differ from one company to another.
Source: medsuprates.com

Supplements & other insurance

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Source: medicare.gov

AARP® Medicare Supplemental Insurance by United Healthcare

Medicare Supplement Insurance Plans, insured by UnitedHealthcare Insurance Company. If you’re considering a Medicare supplement plan, talking to an agent/producer may offer the direct assistance you’re looking for.
Source: aarpmedicaresupplement.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

Free Medigap Quote & Compare Medigap Plans!

We are committed to helping Americans, such as yourself, confidently choose the best Medigap plan. Our licensed insurance agents are paid a flat commission rate on all insurance carriers so that we can deliver 100% unbiased recommendations on the best insurance solution based on your unique health needs.
Source: gomedigap.com