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

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Source: medicare.gov

Pennsylvania 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

Workers’ compensation and payments

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If you settle your workers’ compensation claim, you must use the settlement money to pay for related medical care before Medicare will begin again to pay for related care. In many cases, before a settlement is reached, the workers’ compensation agency asks Medicare to approve an amount to be set aside to pay for future medical care. Medicare will look at certain medical documentation and approve an amount of money from the settlement. This money must be used up first before Medicare starts to pay for related care that’s otherwise covered and reimbursable by Medicare.
Source: medicare.gov

Workers’ Compensation Medicare Set Aside Arrangements

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

Future Medical Allocation Services

GRG’s evaluation in workers’ compensation and third party liability cases includes satisfying Medicare’s past interests – reimbursement for conditional payments – and evaluating / satisfying Medicare’s future interests – identifying Future Medical Allocations and providing compliant spend-down options to ensure Medicare is not billed prematurely.
Source: garretsongroup.com

MSA Frequently Asked Questions

A WCMSA meets CMS’ criteria for review when: A.The Claimant is currently a Medicare beneficiary and the total settlement value is greater than $25,000. -or- B. The Claimant has a “reasonable expectation“ of Medicare enrollment within thirty (30) months of the settlement date and the anticipated total settlement amount for future medical expenses and disability/lost wages over the life or duration of the settlement agreement is expected to be greater than $250,000. Claimants have a “reasonable expectation” of enrollment where: (1) The claimant has applied for Social Security Disability Benefits. (2) The claimant has been denied Social Security Disability Benefits but anticipates appealing that decision. (3) The claimant is in the process of appealing a denial of or re-filing for Social Security Disability benefits. (4) The claimant is 62 years and 6 months old. (5) The claimant has an End-Stage Renal Disease (ESRD) condition but does not yet qualify for Medicare based upon ESRD. CMS has noted that while they do not wish to review WCMSAs if the thresholds are not met, these thresholds reflect a CMS operational workload standard only. They do not constitute a substantive dollar or “safe harbor” threshold. Medicare beneficiaries must still consider Medicare’s interests in all WC cases and ensure that Medicare is secondary payer to workers’ compensation. 5/11/11 Memorandum, Charlotte Benson, Acting Director, Financial Services Group. See also, WCMSA Reference Guide, cms.gov
Source: atlassettlements.com

What’s Medicare Supplement Insurance (Medigap)?

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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

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

Consumer Guide to Health Care

Medicare is the main insurance for people 65 and older and also provides coverage for some people with disabilities. It is the nation’s largest health insurance program – covering 49 million Americans in 2012. The federal Centers for Medicare and Medicaid Services (CMS), which runs the program, provides lots of information on its  Medicare website. Here is additional information about the program.
Source: wisconsin.gov

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 Health Plans, Coverage And Online Enrollment

*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

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

Posted by:  :  Category: Medicare

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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

Annual Statistical Supplement, 2010

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

Part B Premiums in 2010: Frozen for Many, Higher for Some

About 7.5 million Medicare beneficiaries who don’t have their Part B premiums deducted from their Social Security checks are those whose premiums are paid for by their state Medicaid program. These low-income people are not affected—they still won’t pay the premiums themselves. But the states would have to pick up the tab for the higher premiums. This could affect the number of people covered by Medicaid if state governments, already strapped by falling revenue, cut back on services, consumer advocates say.
Source: aarp.org

2010 Medicare Part D Program Compared to 2009, 2008 and 2007

Reference-Based Pricing – Under these programs, sponsors may require enrollees to pay a defined cost-sharing amount plus supplemental cost-sharing based on the differential in cost between the drug being dispensed and a lower-cost preferred alternative such as a generic equivalent. In contract year 2009, fewer than 10% of Part D contracts used reference-based pricing. Given the complexity of reference-based pricing formulas, it is very difficult to accurately convey the extent of expected out-of-pocket spending for formulary drugs subject to reference-based pricing. For this reason, CMS has been unable to have the Medicare Prescription Drug Plan Finder (MPDPF) calculate correct pricing for drugs subject to reference-based pricing, which may distort projections of out-of-pocket expenditures for some beneficiaries and significantly affect their ability to compare cost-sharing obligations under different plans and choose the plan that best meets their needs. Based on CMS’ experience and the increased complexity, CMS has observed with these programs, CMS will eliminate the option of reference-based pricing in the Part D Prescription Benefit Program (PBP) beginning in CY 2010. The basis for this decision is CMS’ belief that reference-based pricing may be inherently misleading to beneficiaries and inconsistent with their goal of improving transparency with regard to expected beneficiary cost-sharing under the Part D program.
Source: q1medicare.com

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

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Source: medicare.gov

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

Posted by:  :  Category: Medicare

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Source: medicare.gov

What Does Medicare Cover?

Twenty percent of the Medicare-approved amount for some types of care. These are doctor’s appointments, physical therapy, diabetes supplies, durable medical equipment like commode chairs, wheelchairs, and other care. You have to meet your deductible first and then pay 20% of the services you receive.
Source: webmd.com

Medicare Part A Overview: Coverage and Premiums

Hospice care is for the terminally ill who are expected to have six months or less to live. Coverage includes pain-relief and symptom-control prescription drugs, medical and support services, grief counseling, and other services. Care is provided by a Medicare-approved hospice provider who will visit you at your home. Medicare also provides additional care for a hospice patient so that the usual caregiver can take a time of rest. Medicare may not cover all services that are provided to patients who receive hospice assistance.
Source: medicareconsumerguide.com

Kansas Insurance Department

Posted by:  :  Category: Medicare

Insurance consumers and the general public should find everything they need by following "The Department", "Auto/Home", "Health/Life", "Insurance Fraud & Education" and "Other Services " links on the left.
Source: ksinsurance.org

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

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Source: medicare.gov

Kansas Department of Health & Environment: Division of Health Care Finance

               900 SW Jackson, Suite 900 N                  Topeka, Kansas 66612-1220
Source: kdheks.gov

Original Medicare (Part A and B) Eligibility and Enrollment

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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

How to Qualify For Medicaid and CHIP Health Care Coverage

If your state has not expanded Medicaid: You may qualify based on your state’s existing rules. These vary from state to state and may take into account income, household size, family status (like pregnancy or caring for young children), disability, age, and other factors. Because each state and each family situation is different, there’s no way to find out if you qualify without filling out an application.
Source: healthcare.gov

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

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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

How to Choose the Best Medigap Plan

Medigap health plans are basically bookkeeping operations. Unlike Medicare Advantage plans, Medigap plans don’t make any decisions about what to cover. They don’t have networks of doctors or hospitals. All they do is pick up a specified share of your medical bills that Medicare doesn’t pay, such as Part A or Part B deductibles or co-pays. If Medicare paid for it and you still owe a part of the bill, Medigap will pay it, no questions asked.
Source: consumerreports.org

Medicare Supplement Insurance / Medigap Plans

Cigna, Aetna, Mutual of Omaha, United American, AARP (or any other)…. the only diferrence is the color of your card and the monthly premium that you pay. The federal government mtandates the benefits that are offered – so they are all the same. It makes a great deal of sense to shop each and every year. While your premiums may be going up – there are carriers that have reduced premiums.This is where I can help you. I will continually shop all carriers in YOUR area to make sure you do not pay any more than you should. Don’t you pay enough already?There is NO cost to you for using Med Sup Savings….
Source: medsupsavings.com

Five Easy Steps Towards Affordable Supplemental Plan

health care is to enroll for Medicare with your local Social Security office although the Medicare coverage you will receive will only cover certain services and will require you to pay a deductible and co-payments.  As a newly retired senior citizen, you would like to enjoy the rest of your life without concern of declining health and how health care expenses are going to be met.  A Medicare supplement policy is an insurance plan obtained through a private insurance carrier and working in coordination with the Medicare program to pay for costs not covered by Medicare Part A and Part B.  Since there are many types of Medicare supplement plans available, it is important to compare insurance companies and policies available to determine the best Medicare supplement for you and your family.
Source: bestmedicaresupplement.com