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

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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

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 Faces Halt in Medicare Advantage Enrollment

Cigna Corp. said Friday that enrollment into its Medicare Advantage and prescription-drug plans has been halted by the government, posing a challenge to the insurer as it aims to wind up its acquisition by Anthem Inc.
Source: wsj.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

Medicare Supplement Rates Updated Daily

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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

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 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

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

How to compare Medigap policies

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 Rates

To find sample plans and premium rates, click the �Search Medicare Supplement Rates� link below. The pages on this website are printer friendly. Search results may be exported to Microsoft Excel compatible format. If you need assistance with this website, please click the �Contact Us� link.
Source: fldfs.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

IDOI: Medicare Supplement Plans

Medicare Supplement insurance is also called Medigap insurance because it covers the “gaps” in Medicare benefits, such as deductibles and copayments. Medicare Supplement insurance is a private health insurance policy purchased by a Medicare beneficiary. Federal and state law regulates Medicare Supplement policies. Only a Medicare Supplement policy, or a Medigap policy, will help fill gaps in Medicare benefits. Other kinds of insurance may help you pay out-of-pocket health care costs, but they do not qualify as true Medicare Supplement insurance. For example, an employer retirement health plan may pay for prescriptions, vision and dental services, but it may not pay for Medicare deductibles and copayments.
Source: in.gov

How Medicare works with other insurance

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

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 can be primary or secondary to employer insurance

It is very important that you talk to your benefits manager at your job when you become eligible for Medicare, as your employer insurance will work differently with Medicare. Sometimes companies do not realize that you are eligible for Medicare and they may continue to pay primary when they should not be. When the company realizes they may be able to take back money they paid for your medical services while you should have had Medicare and you may be left very large bills.
Source: medicareinteractive.org

Reporting Other Health Insurance

If you have Medicare and other health insurance or coverage, each type of coverage is called a “payer.” When there is more than one payer, “coordination of benefits” rules decide which one pays first. The “primary payer” pays what it owes on your bills first, and then sends the rest to the “secondary payer” to pay. The insurance that pays first is called the primary payer. The primary payer pays up to the limits of its coverage. The insurance that pays second is called the secondary payer. The secondary payer only pays if there are costs the primary insurer didn’t cover.
Source: cms.gov

Medicare as a Secondary Insurance Customer

Often policies have a tendency to overlap or duplicate each other. Take young person’s Medicare health care plans for instance:  often these can reduce the amount paid out by a percentage via a ‘reduction in benefits’ clause, particularly if they are protected under their parent or guardian’s plan. Should this be the case, a secondary insurance policy will pay the balance that is not paid by the primary insurance policy.
Source: bestmedicaresupplement.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

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 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 Supplement Insurance

*Plans K-N provide for different cost-sharing than plans A-G. Plans K and L pay 100% of hospitalization and preventive care Basic Benefits. All other Basic Benefits are paid at 50% (Plan K) and 75% (Plan L). Once you reach the annual limit, the plan pays 100% of the Medicare copayments, coinsurance and deductibles for the rest of the calendar year. The out-of-pocket annual limit does NOT include charges from your provider that exceed Medicare-approved amounts, called “excess charges.” You are responsible for paying excess charges. Plan N covers Basic Benefits after a $20 copay for office visits and a $50 copay for emergency room visits. **The out-of-pocket annual limit may increase each year for inflation. (2017 limits shown) † Network restrictions apply
Source: bcbsil.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 Advantage Florida

There are more than 50 different carriers permitted to sell Medicare Advantage and Part D prescription drug plans in the State of Florida, including United Healthcare, Regence, Optimum Healthcare, Molina, Humana, Coventry, Aetna and BCBS; however, AHF, Capital Health Plan, Careplus, Healthspring of Florida and Healthsun Health Plans are all considered the best options for Floridians, scoring a 4.5/5 stars each.
Source: medicare.net

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.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 Claim form (MS014)

This information was printed Saturday 25 February 2017 from humanservices.gov.au/customer/forms/ms014 It may not include all of the relevant information on this topic. Please consider any relevant site notices at humanservices.gov.au/siteinformation when using this material.
Source: gov.au

Completing the Claim Form

The CMS-1500 claim form is the basic form created by CMS for use by suppliers. Before completing the form, you should determine if you are required to submit your claims electronically (which is standard for a majority of suppliers) or whether you qualify to submit your claims on paper. Electronic filing means that you can complete and submit your claims from your office computer or through a Billing Service or Clearinghouse. All electronic claims processes follow Electronic Data Interchange (EDI) Health Insurance Portability and Accountability Act (HIPAA) transaction standards. We have provided detailed information on EDI in the "submitting your claims" section of this website. You may also learn more by visiting one of the related links below.
Source: cgsmedicare.com

How Original Medicare works

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

How Medicare works with other insurance

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

What Is Medicare Part D? How Does Medicare Work?

Dozens of different drug plans are available to you wherever you live. They include stand-alone drug plans (state-wide plans and some nationally available plans), which you would use if you’re enrolled in the traditional Medicare program; and regional and local Medicare Advantage plans that combine medical and drug coverage in their benefit packages. What will I pay for my drugs? You could pay a different price for the same drug according to the phase of coverage that you’re in at any point during the year. • Deductible: If your plan has a deductible, you pay full price for your drugs until the deductible amount is met and coverage kicks in. “Full price” means the price your plan has negotiated with each drug’s manufacturer. This price may be less that you would pay retail at the pharmacy. • Initial coverage period: Your share of each prescription is either a flat copayment (for example, $20) or a percentage of the drug’s cost (for example, 25 percent). Most plans have three or four levels (known as “tiers”) of copays, rising in price from the least expensive generic drugs through “preferred” brand-name drugs to “nonpreferred” brands and finally to specialty or high-cost drugs. • Coverage gap (“doughnut hole”): In 2016 you pay 45 percent of your plan’s price for brand-name and biologic drugs in the gap and 58 percent for generics. In 2017 you pay 40 percent and 51 percent respectively. Fifty percent of the discount for brand drugs is provided by their manufacturers; the rest of the discount for brand drugs and the whole discount on generics is provided by the federal government. If your plan provides any coverage in the gap, these discounts are applied to your remaining costs. • Catastrophic level of coverage: Your share of each prescription is about no more than 5 percent of the cost of the drug. You would also pay a different price if you receive Extra Help or have additional coverage from elsewhere (such as retiree drug benefits or assistance from a state pharmacy assistance program). Why does the same plan charge different copays for different drugs? Most plans arrange their charges in “tiers.” Typically, Tier 1 is the copay for low-cost generics, Tier 2 for medium-cost “preferred” brand-name drugs, Tier 3 for higher-cost “non-preferred” brand names, and Tier 4 for very expensive or rare drugs. But some plans use more than four tiers and some use only one, charging the same percentage price for all drugs. All plans charge a percentage of the cost (typically 25 or 33 percent) for the most expensive drugs in the highest tier. Why does one plan charge a lot more for the same drug than another plan? Each plan negotiates the price of each drug with its manufacturer. If a plan gets a good discount on one brand-name drug but not on a competing drug used to treat the same condition, the plan charges a lower copay for the former (“preferred”) drug and a higher copay for the latter (non-preferred). Different plans may place the same drug in different tiers of charges varying by as much as $50 or more between tiers. Also, some plans charge a percentage of the cost of a drug, while other plans charge a flat dollar copay, which can cause enormous differences in charges among different plans. That’s why it is important to compare copays (as well as premiums and deductibles) when choosing a plan.
Source: aarp.org

Medicare Basics: Hospital Insurance (Part A) and Medical Insurance (Part B)

Today Medicare Part A and Part B are called Original Medicare. Medicare Part A is also known as hospital insurance, and its beneficiaries can expect inpatient hospital stays in a semi-private room to be covered (a private room is not covered unless it is deemed medically necessary). In addition, rehabilitation and other skilled nursing services are also covered. Home health care is covered but only if it’s medically necessary, and then only on a part-time, intermittent basis; this includes physical, occupational and speech therapies when conducted by a Medicare-approved health agency. Durable medical equipment (DME) such as walkers and wheelchairs are covered, as are other medical supplies. Finally, Part A covers hospice care for terminally ill patients and includes drugs and support services for treating symptoms and relieving pain.
Source: howstuffworks.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

Maryland Medicare Supplement Plans

This restriction means that all beneficiaries in their Medigap Open Enrollment Period are eligible for a Medicare Supplement plan in Maryland, regardless of previous health history and current health status. Once a beneficiary is enrolled in a Medigap plan, renewal is guaranteed each year as well, provided that the beneficiary continues to make monthly premium payments. However, beneficiaries applying for a Medigap plan after the Medigap Open Enrollment Period may have to pay more for coverage or may even be denied coverage completely based on medical status.
Source: ehealthmedicare.com

Maryland Medicare Advantage Plans

The Medicare Advantage (Medicare Part C) program in Maryland (and other states) offers an alternative for the beneficiary looking for coverage equal to or beyond what is offered through Original Medicare. Medicare Advantage plans provide all the same coverage as Original Medicare (except for hospice care, which is still covered under Medicare Part A), but usually include additional benefits as well. These additional benefits may vary from plan to plan and may include vision care, hearing services and devices, dental care, wellness programs, and prescription drug benefits.
Source: ehealthmedicare.com

Maryland Medicare Part D Plans

For Maryland residents who need help paying for their medications, the Maryland Medbank Program is another resource.  A charitable organization, the Maryland Medbank offers assistance with prescription drug costs to chronically ill and low-income residents of Maryland. This program helps eligible individuals apply for financial assistance to many pharmaceutical manufacturers, who may then provide medicines for free or at discounted prices. To be eligible, Maryland residents must not be enrolled in any prescription drug programs, must be above the monthly poverty income guidelines, and must be below monthly income guidelines set by the individual drug companies. Some programs require a Maryland resident to be enrolled in the Medicare program while others only require a physician’s signature.
Source: planprescriber.com