Medicare Plans for Different Needs

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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

Compare Medicare Advantage & Supplemental Plans

Medicare supplement plans offer benefits in addition to the benefits offered by Original Medicare Parts A and B, and they are offered by private insurance companies. There are several different types of Medicare supplement plans available, including Plan A, Plan C, Plan F, Plan M and Plan N. Medicare supplement plans and Medicare Advantage plans are not complementary, so it is important to understand which type of policy makes the most sense for you. Our licensed sales agents are standing by to walk you through a comparison of the costs and benefits of each type of plan, and to help you choose a Medicare supplement plan that best meets your needs.
Source: medicaresolutions.com

Health Insurance & Medicare Advantage Plans

Posted by:  :  Category: Medicare

Recent news coverage about possible changes to the Affordable Care Act may have you wondering about your health coverage. At this time there haven’t been any changes announced. Most Americans still need to have health insurance and could pay a tax penalty if they do not have coverage.
Source: healthnet.com

Health Net: Login to the site

Health Net currently offers Medicare Advantage (MA) Plans and Medicare Advantage Plan with prescription drug coverage (MA-PD) to eligible individuals who want more coverage than what Original Medicare covers. Health Net in conjunction with AHIP’s Insurance Education Department is requiring an on-line certification and annual recertification course, Marketing Medicare Advantage and Part D Prescription Drug Plans: Understanding Medicare Basics, Plan Types, Marketing and Enrollment Requirements to new and already contracted producers. This on-line certification and annual recertification program provides the information needed to:
Source: cmpsystem.com

2017 HealthNet Medicare Advantage Plans in Oregon

If you get Medicare due to a disability, you can join during the 7-month period that begins 3 months before your 25th month of entitlement to disability payments, includes your 25th month, and ends 3 months after your 25th month of entitlement to disability payments. Your coverage will begin the first day of the month after you ask to join a plan. If you join during one of the 3 months before you first get Medicare, your coverage will begin the first day of your 25th month of entitlement to disability payments.
Source: oregonhealth-insurance.com

Medicare Advantage Plans in Michigan

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Medicare Advantage plans are a lot like the health insurance you may have had before becoming eligible for Medicare. You can choose a complete insurance package with the convenience of one ID card for all services.
Source: bcbsm.com

BCBS Medicare Advantage Plans

This insurance carrier understands the importance of Medicare, and they’ve gone to great lengths to ensure its continued success among beneficiaries. This is vital, as research suggests that the country’s senior citizen population of number of senior citizens will grow to 90 million by 2050, adding to the demand for healthcare services. In addition, over a 20-year period, a 65-year-old couple’s average total medical expenses will be $218,000, in addition to what Medicare already covers. As such, in April 2015, the carrier announced the launch of a private health insurance exchange, designed to assist Medicare-eligible retirees with the switch from group health benefits to individual Medicare Advantage coverage, including MA, Part D and Medigap plans.
Source: medicare.net

Medicare PPO Blue PlusRx (PPO)

You do not currently have end-stage renal disease (ESRD). If you initiated dialysis treatments for ESRD but have recovered your normal kidney function and no longer require a regular course of dialysis to maintain life, or have had a successful kidney transplant, or are currently a member of Blue Cross Blue Shield of Massachusetts, you may still join the plan. In addition, if you were a member of a Medicare Advantage plan that terminated its services after December 31, 1998, and you currently have ESRD, you may still join the plan. There may be additional requirements. Please contact the plan for details.
Source: bluecrossma.com

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.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 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

Priority Health Medicare Insurance Plans

Posted by:  :  Category: Medicare

In addition to Medigap, Priority Health provides Medicare Advantage Plans, approved Part C alternative plans that work separately from Original Medicare. Priority Medicare Advantage Plans are marketed as Priority Medicare Ideal, Priority Medicare Value, Priority Medicare Merit, and Priority Medicare Select, and they work as either Health Maintenance Organizations or Preferred Provider Organizations. These plans offer a variety of benefits, such as subsidized prescriptions and inexpensive or free preventive care.
Source: medicaresolutions.com

Priority Health Medicare Supplement Plan N for Michigan (Medigap Plan)

Be aware that insurance companies may use one of three price rating systems to set their premium prices: community-rated, issue-age-rated, or attained-age-rated. Community-rated plans set premiums that are the same for all beneficiaries, regardless of age. Issue-age-rated plans set premiums based on the age of beneficiaries when they are “issued” their Medicare Supplement plan. Attained-age plans are said to be the most expensive, with premiums initially set based on beneficiaries’ issue age that increase as beneficiaries age. Premiums may widely differ depending on the rating system used to set these prices.
Source: medicarewire.com

Signing up for Part A & Part B

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Source: medicare.gov

Enrolling in Medicare Part B if you are 65 or older, still working (or spouse is still working), and have insurance from that job

If you are thinking about turning down Part B—or enrolling in only Part A—you should call the Social Security Administration at 800-772-1213 and ask if you can defer enrollment without penalty.  Be sure to explain the type and source of your other insurance and other circumstances in as much detail as possible. When you call Social Security, make sure to write down whom you spoke to, when you spoke to them, and what they said.  As noted above, to avoid a penalty, you generally must be covered under employer health insurance that is available to you because of your or your spouse’s (or in more limited circumstances a family member’s) current work.  The rules for determining what counts as an employer health insurance plan and what counts as current work are specific, so be sure that your situation falls within the rules before you make a decision.
Source: medicareinteractive.org

Enrolling in Medicare Part D

You may choose to hold off on Medicare Part D prescription drug enrollment if you already have creditable prescription drug coverage, such as through an employer group plan. Creditable prescription drug coverage is coverage that is at least as good as standard Medicare prescription drug coverage. If you do not have creditable drug coverage for more than 63 consecutive days, you may have to pay a late-enrollment penalty if you decide to get Medicare prescription drug coverage at a later date. You may have to pay this late-enrollment penalty for as long as you have Medicare Part D.
Source: ehealthmedicare.com

Medicare.gov: the official U.S. government site for Medicare

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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 Plan Finder Glossary

Medication Therapy Management (MTM) Programs offer free services to eligible members of Medicare drug plans. These services help make sure that medications are working to improve their members’ health. Members can talk with a pharmacist or other health professional and find out how to get the most benefit from their medications. Members can ask questions about costs, drug reactions, or other problems. Each member gets their own action plan and medication list after the discussion. These can be shared with their doctors or other health care providers. Members who take different medications for more than one health condition may contact their drug plan to see if they’re eligible.
Source: medicare.gov

Drug Finder: Find which 2017 Medicare Part D plans best covers your drugs

- Copay / Coinsurance – These figures apply to the initial coverage phase of your plan. This is the phase after the initial deductible has been met and before you reach the Coverage Gap (Donut Hole). Plans often cover drugs in “tiers”. Tiers are specific to the list of drugs covered by the plan. Plans may have several tiers, and the copay for a drug depends on which tier the drug is in. The drug Tier is shown to the left of this column. These cost sharing figures DO NOT necessarily apply to the Coverage Gap. The plan may have a separate copay/coinsurance for the same drug while in the Coverage Gap. There are two figures shown under this “Cost Sharing” category:
Source: q1medicare.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

Contact Information and Websites of Organizations for Medicare

Posted by:  :  Category: Medicare

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Source: medicare.gov

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

Medigap vs. Medicare Advantage Plan

Medicare Advantage comprises a variety of private health plans — most often HMOs and PPOs — that Medicare offers as a coverage alternative to the traditional program. Every plan must cover all the same benefits that traditional Medicare covers. But the plans can charge different copayments (often lower than the traditional program but not always) and offer extra benefits. Most charge a monthly premium in addition to the Part B premium, but some don’t. Most include prescription drug coverage at no additional cost. Some cover routine hearing and vision services, usually as a separate package for an additional premium. All plans, by law, have annual limits on out-of-pocket costs. Another difference from the traditional program is that most plans require you to go to doctors and other providers within their service network or pay higher copays for going out of network.
Source: aarp.org

Medicare.gov: the official U.S. government site for Medicare

Posted by:  :  Category: Medicare

The page could not be loaded. The Medicare.gov Home page currently does not fully support browsers with "JavaScript" disabled. Please note that if you choose to continue without enabling "JavaScript" certain functionalities on this website may not be available.
Source: medicare.gov

Electronic Billing & EDI Transactions

The information in this section is intended for the use of health care providers, clearinghouses and billing services that submit transactions to or receive transactions from Medicare fee-for-service contractors. EDI is the automated transfer of data in a specific format following specific data content rules between a health care provider and Medicare, or between Medicare and another health care plan. In some cases, that transfer may take place with the assistance of a clearinghouse or billing service that represents a provider of health care or another payer. EDI transactions are transferred via computer either to or from Medicare. Through use of EDI, both Medicare and health care providers can process transactions faster and at a lower cost. Please see pages on specific types of EDI conducted by Medicare for related links and downloads as applicable.
Source: cms.gov

Medicare Coding & Billing

New Physical Therapy Evaluation and Reevaluation CPT Codes PTs must begin using 3 new evaluation codes and a new reevaluation code beginning January 1, 2017. Now is the time to become familiar with them.
Source: apta.org

Medicare Fee, Payment, Procedure code, ICD, Denial

Interv hlth/behav fam no pt Coverage Indications, Limitations, and/or Medical Necessity Indications The Health and Behavioral Assessment, initial (CPT code 96150) and Reassessment (CPT code 96151), and Intervention services (CPT codes 96152-96153) may be considered reasonable and necessary for the patient who meets all of the following criteria: The patient has an underlying physical illness or injury, and There are indications that biopsychosocial factors may be significantly affecting the treatment or medical management of an illness or an injury, and The patient is alert, oriented and has the capacity to understand and to respond meaningfully during the face-to-face encounter, and The patient has a documented need for psychological evaluation or intervention to successfully manage his/her physical illness, and activities of daily living, and The assessment is not duplicative of other provider assessments In addition, for a reassessment to be considered reasonable and necessary, there must be documentation that there has been a sufficient change in the mental or medical status warranting re-evaluation of the patient’s capacity to understand and cooperate with the medical interventions necessary to their health and well being. Health and Behavioral Intervention (with the family and patient present) (CPT code 96154) is considered reasonable and necessary for the patient if the family representative directly participates in the overall care of the patient. Limitations Health and Behavioral Assessment/Intervention will not be considered reasonable and necessary for the patient who: Does not have an underlying physical illness or injury, or For whom there is no documented indication that a biopsychosocial factor may be significantly affecting the treatment, or medical management of an illness or injury (i.e., screening medical patient for psychological problems), or Does not have the capacity to understand and to respond meaningfully during the face to face encounter, because of: Dementia that has produced a severe enough cognitive defect for the psychological intervention to be ineffective. Delirium Severe and profound mental retardation Persistent vegetative state/no discernible consciousness, Impaired mental status, e.g., Disorientation to person, time, place, purpose, or Inability to recall current season, location of own room, names and faces, or Inability to recall that he or she is in a nursing home or skilled nursing facility, or Does not require psychological support to successfully manage his/her physical illness through identification of the barriers to the management of physical disease and activities of daily living, or For whom the conditions noted under the indications portion of this section are not met. Because it does not represent a diagnostic or treatment service to the patient, there is no coverage for CPT code 96155. Examples of Health and Behavioral Intervention services not considered reasonable and necessary and not covered are: Provide family psychotherapy or mediation Maintain the patient’s or family’s existing health and overall well-being Provide personal, social, recreational, and general support services. Although such services may be valuable adjuncts to care, they are not medically necessary psychological interventions. Individual social activities Teaching social interaction skills Socialization in a group setting Vocational or religious advice Tobacco or caffeine withdrawal support Teaching the patient simple self-care Weight loss management Maintenance of behavioral logs Health and Behavioral Assessment/Intervention (CPT codes 96150-96154) may only be performed by a Clinical Psychologist (CP-Specialty Code 68). Biofeedback is coded as 90901 and will not be covered as a health and behavioral intervention. Bill Type Codes: Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims. 999x
Source: medicarepaymentandreimbursement.com