The Medicare Part D Prescription Drug Benefit

Posted by:  :  Category: Medicare

Medicare Part D is a voluntary outpatient prescription drug benefit for people on Medicare that went into effect in 2006. All 57 million people on Medicare, including those ages 65 and older and those under age 65 with permanent disabilities, have access to the Part D drug benefit through private plans approved by the federal government; in 2016, nearly 41 million Medicare beneficiaries are enrolled in Medicare Part D plans. During the Medicare Part D open enrollment period, which runs from October 15 to December 7 each year, beneficiaries can choose to enroll in either stand-alone prescription drug plans (PDPs) to supplement traditional Medicare or Medicare Advantage prescription drug (MA-PD) plans (mainly HMOs and PPOs) that cover all Medicare benefits including drugs. Beneficiaries with low incomes and modest assets are eligible for assistance with Part D plan premiums and cost sharing. This fact sheet provides an overview of the Medicare Part D program and information about 2017 plan offerings, based on data from the Centers for Medicare & Medicaid Services (CMS) and other sources.
Source: kff.org

How Part D works with other insurance

While prescription drug coverage is an essential health benefit, prescription drug coverage in Marketplace or SHOP plans aren’t required to be at least as good as Part D coverage (creditable). However, all private insurers offering prescription drug coverage, including Marketplace and SHOP plans, must determine if their prescription drug coverage is creditable each year and let you know in writing.
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 Part D Prescription Drug Plans

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Source: cigna.com

Medicare Part D Pharmacy Options

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Source: cigna.com

The United States Social Security Administration

Posted by:  :  Category: Medicare

Social Security was created in 1935 to promote the economic security of the nation’s people. Since then, we’ve integrated programs and services to support millions of people. Get to know your Social Security and learn about our commitment to help secure today and tomorrow.
Source: ssa.gov

SocialSecurity.gov/SSA.gov: The Official Site of the U.S. Social Security Administration

SocialSecurity.gov (or ssa.gov ) is the official website of the U.S. Social Security Administration. Most of the management of your retirement, disability, and government health benefits can be done right on the SocialSecurity.gov website. SocialSecurity.gov contains a wealth of information, so it can give beneficiaries a better idea of what they qualify for, how to apply for benefits, and what benefits they will receive.
Source: ehealthmedicare.com

Medicare Advantage 2015 Data Spotlight: Overview of Plan Changes

Posted by:  :  Category: Medicare

When SNPs were authorized, there were few requirements beyond those otherwise required of other Medicare Advantage plans. The Medicare Improvements for Patients and Providers Act (MIPPA) of 2008 established additional requirements for SNPs, including requiring all SNPs to provide a care management plan to document how care would be provided for enrollees and requiring C-SNPs to limit enrollment to beneficiaries with specific diagnoses or conditions. As a result of the new MIPPA requirements, the number of SNPs declined in 2010. The ACA required D-SNPs to have a contract with the Medicaid agency for every state in which the plan operates, beginning in 2013. Additionally, in 2013, joint federal-state financial alignment demonstrations to improve the coordination of Medicare and Medicaid for dually eligible beneficiaries began to enroll beneficiaries. Today, financial alignment demonstrations are underway in 12 states: California, Colorado, Illinois, Massachusetts, Michigan, Minnesota, New York, Ohio, South Carolina, Texas, Virginia, and Washington. The financial alignment demonstrations could influence the availability of D-SNPs in these states, either increasing or decreasing the availability of SNPs, depending on the design of the demonstration.
Source: kff.org

Changes to Medicare With the Affordable Care Act

You can get most screening services without additional cost. Screenings are medical tests to find illnesses early, when they’re easier to treat. For instance, a mammogram is a screening for breast cancer. A colonoscopy checks for colon cancer. You can also be checked for diabetes, high blood pressure, and high cholesterol.
Source: webmd.com

2012 Medicare Therapy Cap: Changes Effective October 1, 2012

Manual Medical Review Complaint Form If you are experiencing issues with the Medicare therapy cap exceptions process for 2012 or other issues related to the therapy cap and you have been unable to resolve your issues by contacting your Medicare Administrative Contractor (MAC), you may complete this complaint form. APTA staff will contact you within two business days using the information in the form to help you resolve your issue.
Source: apta.org

Big changes coming to Medicare in 2016

PBS NewsHour allows open commenting for all registered users, and encourages discussion amongst you, our audience. However, if a commenter violates our terms of use or abuses the commenting forum, their comment may go into moderation or be removed entirely. We reserve the right to remove posts that do not follow these basic guidelines: comments must be relevant to the topic of the post; may not include profanity, personal attacks or hate speech; may not promote a business or raise money; may not be spam. Anything you post should be your own work. The PBS NewsHour reserves the right to read on the air and/or publish on its website or in any medium now known or unknown the comments or emails that we receive. By submitting comments, you agree to the PBS Terms of Use and Privacy Policy, which include more details.
Source: pbs.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

Medicare Part D Formulary Drug List FAQs

Posted by:  :  Category: Medicare

We may make certain changes to our list of covered drugs throughout the year. Changes in the drug list may affect which drugs are covered and how much you will pay when filling your prescription. If we remove drugs from our drug list, or add prior authorization, quantity limits and/or step therapy restrictions on a drug or move a drug to a higher cost cost-sharing tier, we will post a notice on this site at least 60 days before the change becomes effective. In addition, you will be notified on your Explanation of Benefits (EOB) mailing, if you are taking the affected drug.
Source: cigna.com

Hospice care coverage in Part A

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 & Cost of Hospice

VITAS hospice patients who meet those qualifications will have their hospice care covered by Medicare. For care unrelated to a patient’s terminal illness, Medicare and Medicaid continue to provide their usual benefits. Since each private insurance company has its own policies regarding hospice coverage, VITAS can contact the patient’s insurer to ask about coverage provided. However, VITAS is committed to admitting and caring for all hospice-appropriate patients who are referred to us, regardless of their insurance coverage or ability to pay.
Source: vitas.com

Tinkering With Hospice: The Medicare Care Choices Model 

In an effort to address this problem, The Affordable Care Act of 2010 directed the Secretary of Health and Human Services (Secretary) to establish a three-year Medicare Hospice Concurrent Care demonstration project which would allow patients otherwise eligible for hospice care to also receive all other Medicare covered services while receiving hospice care.  The hospice providers selected for the project are supposed to undergo an "independent evaluation" regarding patient care, quality of life, and spending in the Medicare program.  The Secretary is directed to ensure that the aggregate Medicare expenditures for the three-year period shall not exceed what should have been the aggregate expenditures if the demonstration project had not been implemented.[3]  According to Senate Finance Committee Chairman Ron Wyden (D-Ore), who wrote the provision into the Affordable Care Act, "Patients and their families should have every choice available to them when faced with a life-threatening illness.  Allowing Medicare coverage to continue while under hospice care means that patients no longer have to make a false choice between hospice and curative care."[4]
Source: medicareadvocacy.org

Welcome to Arkansas Medicaid

Posted by:  :  Category: Medicare

In an effort to resolve claims denied for eligibility beginning with dates of service on 10/1/2013, Arkansas Medicaid has made modifications to bypass the timely filing edits. Claims are to be submitted electronically. Providers must verify that an eligibility segment for the dates of service in question is available on file and verify that a PCP, if required, is on file before the claim is submitted. Providers will have an open window between October 17, 2016 and April 15, 2017 to submit claims. A listing of permissible reasons for qualifying claims may be obtained on this FAQ document
Source: ar.us

Arkansas Medicaid Program

Medicaid provides health coverage to millions of Americans, including children, pregnant women, parents, seniors and individuals with disabilities.  In some states the program covers all low-income adults below a certain income level.
Source: benefits.gov

Arkansas Medicaid Eligibility & Benefits Guide

Have you ever checked to see if you and your family are eligible for Medicaid? It seems like a simple question, but there are many individuals and families in America who are unaware that they actually qualify for Medicaid either because their state expanded it under the Affordable Care Act or because they only make a certain amount of money each year in the states that did not.
Source: govthub.com

Welcome to Arkansas Medicaid

Use of this application is restricted to authorized users. User activity is monitored and recorded by system personnel. Anyone using this application expressly consents to such monitoring and recording. BE ADVISED: if possible criminal activity is detected, system records, along with certain personal information, may be provided to law enforcement officials.
Source: ar.us

Health Insurance Plans for Individuals & Families, Employers, Medicare

Posted by:  :  Category: Medicare

UnitedHealthcare offers health insurance plans to meet the needs of individuals and employers. Plus we offer dental, vision and many other insurance plans to help keep you and your family healthy. 
Source: uhc.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 Information, Help, and Plan Enrollment

Humana is a Medicare Advantage [HMO, PPO and PFFS] organization and a stand-alone prescription drug plan with a Medicare contract. Enrollment in any Humana plan depends on contract renewal. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments and restrictions may apply. [Benefits, premiums and/or member cost-share] may change on January 1 of each year. The [Formulary, pharmacy network, and/or provider network] may change at any time. You will receive notice when necessary.
Source: medicare.com

Australian Government Department of Human Services

This information was printed Friday 17 March 2017 from humanservices.gov.au/ 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

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

Registration & Attestation

CMS allows an eligible professional to designate a third party to register and attest on his or her behalf. To do so, users working on behalf of an eligible professional must have an Identity and Access Management System (I&A) web user account (User ID/Password), and be associated to the eligible professional’s National Provider Identifier (NPI). If you are working on behalf of one or more eligible professionals and do not have an I&A web user account, please visit I&A Security Check to create one. (Note: States will not necessarily offer the same functionality for registration and attestation in the Medicaid EHR Incentive Program. Check with your State to see what functionality will be offered.)
Source: cms.gov

Medicare enrolment application form (3101)

This information was printed Friday 17 March 2017 from humanservices.gov.au/customer/forms/3101 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

Medicare Enrollment Archives

A Special Enrollment Period (SEP) allows you to sign up for Original Medicare Part A and/or Part B outside of regular enrollment periods. If you’re not eligible for an SEP, you’ll have to wait until the next General Enrollment Period to sign up for Part A… Read more
Source: medicare.com

Medicare Eligibility and Enrollment

good as Medicare’s or better, you shouldn’t be charged a late penalty as long as you sign up within the deadlines. After insurance from an employer ends, you must sign up for Part B within 8 months and for Part D within 63 days. Keep in mind that an insurance policy from an employer with fewer than 20 employees works differently with Medicare. If you work for a company of that size, you should sign up for Medicare when you are first eligible. You will not incur penalties if you don’t, but without Medicare Part B coverage, you could be without coverage for outpatient services.
Source: webmd.com

MyMedicare.gov: Getting Started and Registering Online

Register with the same address that the SSA or RRB has on file for you. During Registration, we’ll ask you to validate your address. This is an important step to protect your personal information, because Medicare may send you mail at this address that contains important personal account information.
Source: mymedicare.gov