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

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

Medicare Supplement Plan F

Medicare Supplement Plan F is generally regarded as the most comprehensive plan out of the 10 Medicare Supplement (Medigap) policies available in most states. Its extensive coverage makes this a popular plan for beneficiaries who want broader assistance with out-of-pocket costs in Original Medicare; however, this also means that premiums may be more expensive. Because Plan F covers most remaining hospital and doctor costs after Original Medicare (Part A and Part B) has paid its share, it’s possible for beneficiaries with this plan to not have any or minimal other hospital and medical expenses.
Source: ehealthinsurance.com

Costs in the coverage gap

Posted by:  :  Category: Medicare

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

Medicare Part D coverage gap

The Medicare Part D coverage gap (informally known as the Medicare donut hole) is a period of consumer payment for prescription medication costs which lies between the initial coverage limit and the catastrophic-coverage threshold, when the consumer is a member of a Medicare Part D prescription-drug program administered by the United States federal government. The gap is reached after shared insurer payment – consumer payment for all covered prescription drugs reaches a government-set amount, and is left only after the consumer has paid full, unshared costs of an additional amount for the same prescriptions. Upon entering the gap, the prescription payments to date are re-set to $0 and continue until the maximum amount of the gap is reached: copayments made by the consumer up to the point of entering the gap are specifically not counted toward payment of the costs accruing while in the gap.
Source: wikipedia.org

Medicare 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

How does this Donut Hole really work?

I use medications not covered by my Medicare Part D plan or sometimes I buy my medications from outside of the country (for instance, in Canada or Mexico). Are these prescription drug expenses included in the $3700 or any other Part D calculation? No. Any medications not included on your Medicare Part D plan’s formulary or drug list (also known as: out of formulary drugs) or drugs that you purchased outside of the United States fall outside of your Medicare Part D coverage and are not included in the $3700 or any other Part D calculation. If you use a medication that is not included on your formulary, you can ask your Medicare Part D plan for a formulary exception or coverage determination, whereby your non-formulary drug would be included on your own personal formulary. If your Medicare Part D plan denies your request for a coverage determination, you can appeal the denial – several times. Be sure to ask your Medicare Part D plan for details on the formulary exception and appeals process.
Source: q1medicare.com

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

Obama administration budget proposes cuts for Medicare Advantage

Posted by:  :  Category: Medicare

Unlike standard Medicare, in which doctors and hospitals bill for each service they provide, private Medicare Advantage plans and other managed care organizations are often paid a flat monthly rate for each patient using a formula called a “risk score” that estimates the health challenges facing individual patients.
Source: publicintegrity.org

Report: Proposed Cuts to Medicare Advantage Would Increase Costs, Decrease Choice for Seniors

“CMS proposed to modify the Employer Group Waiver Plans bidding process to provide these plans with a fair benchmark, reflective of comparable local Medicare Advantage trends and prices,” a Centers for Medicare and Medicaid Services spokesperson said. “This proposal addresses the fact that Employer Group Waiver Plans do not compete against other Medicare Advantage plans to serve a particular population.”
Source: freebeacon.com

Medicare Advantage Cuts in the Affordable Care Act: April 2014 Update

The overwhelming majority of Medicare Advantage enrollees will face significant benefit cuts in 2015, relative to benefit levels in 2014. This is primarily the result of ACA-mandated changes to the benchmark payment formula, and the elimination of the star rating bonus pilot program. The cuts are somewhat mitigated by changes in risk adjustment and other factors. Compared to the pre-ACA baseline, all beneficiaries are experiencing a substantial benefit reduction. The overwhelming majority of this reduction is due to ACA-mandated changes to the benchmark formulas in effect in 2010 and prior years. The effect of the star rating pilot program is absent, since star ratings were not used to determine payments at all prior to 2012. The effect of year-to-year (and even cumulative) adjustment factors is small compared to the cumulative effects of the benchmark changes mandated by the ACA.
Source: americanactionforum.org

Medicare Advantage Under the ACA: Replace Payment Cuts with Market

Use market-based bids for benchmark payments. Congress should delink benchmark payments from FFS and instead base payment solely on the bids that MA plans submit to the CMS to provide the traditional Medicare benefit (Parts A and B) to MA beneficiaries. There are a variety of ways to do this. For example, the new MA benchmark payment could be based on the weighted average bid of all plans in each county.[46] Under this method, each bid would be weighted by the proportion of beneficiaries enrolled in that plan in the preceding year. The benchmark payment could also be set at the levels proposed under various premium support proposals, such as the second-lowest cost plan[47] or the average of the three lowest-cost plan bids.[48] Bids would reflect the cost of providing benefits for a beneficiary in average health, and insurers would receive larger or smaller risk-adjusted payments from the government if an enrollee’s health was worse or better than average. If a plan were to bid higher than the benchmark payment, enrollees would pay the difference through increased premiums. If a plan were to bid below the benchmark payment, enrollees would receive the difference in a plan rebate.
Source: heritage.org

ObamaCare Medicare: ObamaCare and Medicare

ObamaCare now requires that Advantage plans cannot charge enrollees more than traditional Medicare for chemotherapy administration, skilled nursing home care and other specialized services. Starting in 2014, Medicare Advantage plans cannot spend more than 15 % of their Medicare payment on administrative costs, insurance company profits and non-healthcare related items. These cost cutting measures are estimated to bring in $1,000 in savings to CMS per Advantage Plan member without reducing any benefits. This is expected to help decrease Medicare part B payments, especially for low income seniors. Remember: Medicare Advantage Plans must provide at a minimum what Original Medicare covers.
Source: obamacarefacts.com

Choose Your Viva Medicare Plan

Posted by:  :  Category: Medicare

The Annual Enrollment Period is a great opportunity for you to review your current plan information, compare Medicare Advantage plans, and make the changes necessary to find a plan that best fits your budget.
Source: makingmedicareeasy.com

Choose Your Viva Medicare Plan

The Annual Enrollment Period is a great opportunity for you to review your current plan information, compare Medicare Advantage plans, and make the changes necessary to find a plan that best fits your budget.
Source: vivamedicareenrollment.com

Coventry Medicare: First Health Part D

Posted by:  :  Category: Medicare

First Health Part D (Legal Disclaimers) Aetna Medicare is a PDP, HMO, PPO plan with a Medicare contract. Our SNPs also have contracts with State Medicaid programs. Enrollment in our plans depends on contract renewal. See Evidence of Coverage for a complete description of benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by service area. ©2016 Aetna Inc. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next. Our dual-eligible Special Needs Plan is available to anyone who has both Medical Assistance from the state and Medicare. Premiums, copays, coinsurance and deductibles may vary based on the level of Extra Help that you receive. Please contact the plan for further details. You must continue to pay your Medicare Part B premium. The Part B premium is covered for full-dual members. This information is available for free in other languages. Please call our customer service number at 1-844-233-1938 (TTY: 711) OR Coventry Health Care at 1-877-988-3589 (TTY: 711), 8 a.m. to 8 p.m., seven days, from October 1 – February 14; 8 a.m. to 8 p.m. Monday – Friday, from February 15 – September 30. Esta información está disponible en otros idiomas de manera gratuita. Comuníquese con Servicios al Cliente al 1-844-233-1938 (TTY: 711), de 8 am a 8 pm, siete días a la semana, desde el 1 de octubre hasta el 14 de febrero, y de 8 am a 8 pm, de lunes a viernes, desde el 15 de febrero hasta el 30 de septiembre. Medicare beneficiaries may also enroll in Coventry plans through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov. For mail-order, you can get prescription drugs shipped to your home through the network mail-order delivery program. Typically, mail-order drugs arrive within 7 to 14 days. You can call First Health Part D at 1-844-233-1938 (TTY: 711), 8 a.m. to 8 p.m., local time, seven days, from October 1 – February 14; 8 a.m. to 8 p.m. Monday – Friday, from February 15 – September 30, if you do not receive your mail-order drugs within this timeframe. [Members may have the option to sign-up for automated mail-order delivery.] Cost sharing for members who get “Extra Help” is the same at preferred and network pharmacies. The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary. Participating physicians, hospitals and other health care providers are independent contractors and are neither agents nor employees of Aetna. The availability of any particular provider cannot be guaranteed, and provider network composition is subject to change. This material is for informational purposes only and is not medical advice. Health information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professional. Contact a health care professional with any questions or concerns about specific health care needs. Providers are independent contractors and are not agents of Aetna. Provider participation may change without notice. Aetna is not a provider of health care services and, therefore, cannot guarantee any results or outcomes. The availability of any particular provider cannot be guaranteed and is subject to change. Information is believed to be accurate as of the production date; however, it is subject to change. For more information about Aetna plans, refer to www.aetnamedicare.com
Source: coventryhealthcare.com

First Health Part D Value Plus (PDP) for Maine

If you reach the ICL (most seniors don’t), then you are responsible for 100% of your prescription costs until your out-of-pocket costs hit $4,550 (excluding your monthly premiums and the amount paid by the plan). This is called the coverage gap or donut hole. The good news is that you get a 47.5% discount on brand-name prescription drugs and a 28% discount on generic drugs while you’re in the gap. You get to the other side of the donut hole when you’ve spent $4,550, at which point you automatically qualify to receive catastrophic coverage from Medicare.
Source: medicarewire.com

Medicare Eligibility and Enrollment

Posted by:  :  Category: Medicare

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

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.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 Eligibility, Age, Qualifications And Requirements

You can also qualify for premium-free Part A benefits on your spouse’s work record if he or she is at least age 62 and you are at least age 65. You also may qualify on the work record of a divorced or deceased spouse. Following the Supreme Court’s 2015 ruling, people in same-sex marriages can qualify for Medicare on their spouse’s work record, regardless of where they live or where they were married.
Source: aarp.org

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

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

Supplements & other insurance

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 Supplement Plans

To be eligible to enroll in a Medicare Supplement plan, you must be enrolled in both Medicare Part A and Part B. A good time to enroll in a plan is generally during the Medigap Open Enrollment Period, which begins on the first day of the month that you are both age 65 or older and enrolled in Part B, and lasts for six months. During this period, you have the guaranteed-issue right to join any Medicare Supplement plan available where you live. You may not be denied coverage based on any pre-existing conditions during this enrollment period (although a waiting period may apply). If you miss this enrollment period and attempt to enroll in the future, you may be denied coverage or charged a higher premium based on your medical history.
Source: ehealthinsurance.com

Medicare Plans for Different Needs

When it comes to Medicare, one size definitely does not fit all. What works for your neighbor may not be the best bet for you. Which is why it’s great to have choices. To find plans that may be a good fit for you, enter your ZIP code in the field below and click the "Find plans" button.
Source: uhcmedicaresolutions.com

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

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 News And Updates

The Centers for Medicare and Medicaid Services (CMS) has released a long list of changes for the Hospital Outpatient Prospective Payment System (OPPS) that are intended to streamline certain systems and encourage quality health care by hospitals and their off-campus affiliate locations. Changes deal primarily with streamlining billing processes, creating more transparency for the patient and increasing compensation for hospitals
Source: medicare.net

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 2017 costs at a glance

The standard Part B premium amount in 2017 is $134 (or higher depending on your income). However, most people who get Social Security benefits 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’ll 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 2017 is $400. After you meet the deductible, Medicare will pay roughly 75% of your prescription costs.
Source: nolo.com

Medicare drug benefit (Part D) costs

and your income is below 100% of the Federal Poverty Level ($11,880 a year in 2016 for individuals and $16,020 a year for couples): $1.20 for generics and $3.70 for brand-name drugs. After your total drug costs reach $7,425, you will get catastrophic coverage and pay $0 for each drug for the rest of the calendar year.If you have Full Extra Help: $3.30 for generics and $8.25 for brand-name drugs. After your total drug costs reach $7,425 you will get catastrophic coverage and pay $0 for each drug for the rest of the calendar year.
Source: medicareinteractive.org

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

The United States Social Security Administration

Posted by:  :  Category: Medicare

On January 23, I became the acting commissioner of Social Security. That makes me responsible for overseeing one of the nation’s largest and most important social insurance programs, providing retirement, survivors, and disability protection…
Source: ssa.gov

Retirement Planner: Plan For Your Retirement

This planner provides detailed information about your Social Security retirement benefits under current law. It also points out things you may want to consider as you prepare for the future. If you are:
Source: socialsecurity.gov

How do I apply for a new or replacement Social Security number card?

If you cannot apply for a card online, you will need to show the required documents. We need to see different documents depending on your citizenship and the type of card you are requesting. See Learn What Documents You Need to find out what documents you will have to show. Fill out and print an Application for a Social Security Card; and take or mail your application and documents to your local Social Security office.
Source: ssa.gov

Social Security Benefits Calculator

Let the Social Security Calculator help you figure out how much retirement income you’ll receive at different claiming ages so you can determine when you should claim Social Security. Can you afford to “retire early” and claim benefits at age 62, should you wait until your full retirement age, or can you wait until age 70 in order to receive the largest possible monthly benefit? Note: This calculator does not display on mobile devices.
Source: aarp.org