Medicare Enrollment Periods: AEP, GEP, OEP, L

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Beneficiaries who want to use the Open Enrollment Period to return to Original Medicare from an MA-PD must do so by enrolling in a PDP. Enrollment in a PDP during either the Annual Coordinated Election Period or the Open Enrollment Period terminates enrollment in a Medicare Advantage plan. Because beneficiaries are generally limited to changing their prescription drug coverage during the Annual Coordinated Election Period, MA-PD enrollees who want to return to Original Medicare during the Open Enrollment Period have a Part D Special Enrollment Period that allows them to make one enrollment into a PDP.
Source: medicareadvocacy.org

Medicare Supplement Open Enrollment Period

As mentioned, the timing of your enrollment may affect your coverage choices and costs. In general, the best time to enroll in a Medicare Supplement plan is during your Medigap Open Enrollment Period. This is the six-month period that starts on first day of the month that you are both 65 or older and enrolled in Medicare Part B. Throughout this period, you can enroll in any Medigap plan offered in your service area with guaranteed issue. This means that insurance companies aren’t allowed to use your medical history or pre-existing conditions as the basis for charging you more for coverage or denying you altogether. If you have medical issues or disabilities, it’s especially important to take advantage of this period: Your Medigap Open Enrollment Period may be one of the few times that you have a guaranteed right to enroll in any Medicare Supplement plan in your area.
Source: ehealthinsurance.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

Medicare Coverage Special Enrollment Period

Talk with your employer health insurance plan administrator before you make any decisions. You need to understand if, and how, your plan may work with Medicare. You may be required to take full Medicare benefits (Parts A and B) at age 65 in some situations, such as if your employer has fewer than 20 employees.
Source: medicaremadeclear.com

Does Medicare ever cover dental services?

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will not cover dental care that you need primarily for the health of your teeth. For example, Medicare will not cover routine checkups, cleanings, or pay for you to get fillings. Medicare will never pay for dentures. Even if Medicare has paid for you to have teeth pulled (extracted) as preparation for a medical procedure, Medicare will not cover the cost of implants or dentures (complete or partial/bridge); you will be responsible for the full cost.
Source: medicareinteractive.org

Dental Insurance for Seniors on Medicare

Savings plans are NOT insurance and the savings will vary by provider, plan and zip code. These plans are not considered to be qualified health plans under the Affordable Care Act. Please consult with the respective plan detail page for additional plan terms. The discounts are available through participating healthcare providers only. To check that your provider participates, visit our website or call us. Since there is no paperwork or reimbursement, you must pay for the service at the time it’s provided. You will receive the discount off the provider’s usual and customary fees when you pay. We encourage you to check with your participating provider prior to beginning treatment. Note-not all plans and offers available in all markets. Special promotions including, but not limited to, additional months free are not available to California residents.
Source: medicarewire.com

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

Help fight Medicare fraud

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

Report Medicare Fraud and Medicaid Fraud and get a whistleblower reward

The largest area of fraud against the government today is against Medicare fraud and Medicaid fraud. Approximately 10% of all Medicare/Medicaid bills are inflated or fraudulent. That helps explain why the Department of Justice pays such large whistleblower rewards for reporting Medicare fraud.
Source: howtoreportfraud.com

Medicare Fraud Waste and Abuse Training

In response to the rise in the number of health care fraud and abuse cases and the escalating cost of health care services, the U.S. Centers for Medicare and Medicaid Services (CMS) has instituted compulsory training and compliance programs for individuals and organizations who provide health or administrative services to Medicare or Medicaid enrollees or who receive payments from the Medicare/Medicaid system. These training and compliance programs help establish fundamental expectations for compliance, disclosure, transparency, and quality of care.
Source: fraudwasteandabusetraining.com

Criminal and Civil Enforcement

Cardiologist, Neurologist, And Others Charged In $50 Million Health Care Fraud Scheme, And Civil Suit Filed Against Clinic And Participants In The Fraud Preet Bharara, the United States Attorney for the Southern District of New York, William F. Sweeney Jr., the Assistant Director-in-Charge of the New York Field Office of the Federal Bureau of Investigation (“FBI”), Scott J. Lampert, Special Agent-in-Charge of the New York Regional Office of the United States Department of Health and Human Services Office of the Inspector General (“HHS-OIG”), and James P. O’Neill, the Commissioner of the New York City Police Department (“NYPD”), announced today criminal and civil actions relating to a 12-year scheme to defraud Medicaid, Medicare, and other private health insurance companies out of more than $50 million. Today’s actions include the unsealing of an Indictment charging ASIM HAMEEDI, FAWAD HAMEEDI, MICHELLE LANDOY, DESIREE SCOTT, EMAD SOLIMAN, and ARIF HAMEEDI with, among other things, health care fraud, identity theft, and making false statements, and the filing of a civil fraud lawsuit against CITY MEDICAL ASSOCIATES, P.C., and ASIM HAMEEDI, among others, seeking treble damages and civil penalties under the False Claims Act for the fraudulent claims for reimbursement submitted by CITY MEDICAL ASSOCIATES to Medicare and Medicaid between 2003 and November 2015.
Source: hhs.gov

Medicare Supplement Plan F

Posted by:  :  Category: Medicare

Medicare Supplement Plan F, administered by Premera Blue Cross, allows the use of any Medicare contracted physician or hospital nationwide. The plan is designed to supplement your Medicare coverage by reducing your out-of-pocket expenses and providing additional benefits. It pays some Medicare deductibles and coinsurances, but primarily supplements only those services covered by Medicare.
Source: wa.gov

Washington State Department of Commerce

The Department of Commerce is the one agency in state government that touches every aspect of community and economic development: planning, infrastructure, energy, public facilities, housing, public safety and crime victims, international trade, business services and more. We work with local governments, businesses and civic leaders throughout the state to strengthen communities so all residents may thrive and prosper.
Source: wa.gov

State Pharmaceutical Assistance Programs

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

Understanding Medicare Payment Reform

Posted by:  :  Category: Medicare

A final rule released on Oct. 14, 2016 by the Centers for Medicare and Medicaid Services (CMS) details the final regulations for implementation of the Medicare Access and CHIP Reauthorization Act (MACRA), the historic Medicare reform law that repealed the Sustainable Growth Rate (SGR) formula and created the Quality Payment Program (QPP). Read the AMA summary (PDF) or view the key changes in the QPP final rule (PDF).
Source: ama-assn.org

Florida Blue Medicare Advantage Plans for 2017

Posted by:  :  Category: Medicare

Are you a Florida senior citizen who is trying to maximize your Medicare benefits? Just as each senior citizen has her own unique needs and preferences, insurers offer a variety of different ways to enjoy these hard-earned health benefits and even help you plan for medical expenses that original Medicare does not completely cover. At Secure Health Options, we want to help all Floridians find the right plan that assures them of convenient and affordable access to the best medical providers. You can request information on 2017 Medicare Advantage plans and Florida Medicare supplemental insurance in your own local area by entering your home ZIP code in the box at the top of this page. If you have questions or would like help signing up, be sure to give us a call.
Source: floridamedicareadvantageplans.com

2017 Florida Medicare Supplement Insurance Plans

The key to finding the perfect plan is to have all of the information in front of you so you can compare plans. Keep in mind, there are significant differences between lettered plans and it makes sense to review everything to ensure you’re making the best choice. Some plans provide coverage if you travel outside the United States, others do not. At Secure Health Options, we can help you locate these options with Florida Blue so you can have all the information you need to make the right decision, easily and conveniently.
Source: myfloridamedicareplan.com

Florida Department of Children and Families

This may result in fines of up to $250,000, a prison term or both, if you are convicted of public assistance fraud. In addition you will not be able to get benefits for 12 months the first time, 24 months the second time, and permanently the third time that you provide false or inaccurate information.
Source: myflorida.com

Compare Medicare Supplement (Medigap) Plans and Rates in Your Area

Posted by:  :  Category: Medicare

"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

Medicare Provider Utilization and Payment Data

CMS has released a series of publicly available data files that summarize the utilization and payments for procedures, services, and prescription drugs provided to Medicare beneficiaries by specific inpatient and outpatient hospitals, physicians, and other suppliers. These Medicare Provider Utilization and Payment Data files include information for common inpatient and outpatient services, all physician and other supplier procedures and services, and all Part D prescriptions. Providers determine what they will charge for items, services, and procedures provided to patients and these charges are the amount that providers bill for an item, service, or procedure.
Source: cms.gov

Medicare Supplement Insurance

To help consumers understand and compare Medicare Supplement insurance plans (Medigap plans), the 10 available policies were standardized by the National Association of Insurance Commissioners (NAIC). These standards can be found in NAIC’s Medicare Supplement Insurance Minimum Standards Model Act. The 10 Medigap plans have letter designations ranging from A to N, each with a set of basic and extra benefits. The combination of benefits in each plan may not be altered by insurers, nor may the letter designations be changed. Three states – Massachusetts, Minnesota, and Wisconsin are referred to as waiver states because they are permitted by statute to have different standardized Medigap plans.
Source: medicare-solutions.org

Calculating Medicare Fee Schedule Rates

MPPR is a per-day policy that applies across disciplines and across settings. For example, if an SLP and a physical therapist both provide treatment to the same patient on the same day, the MPPR applies to all codes billed that day, regardless of discipline. Under MPPR, full payment is made for the therapy service or unit with the highest practice expense value (MPFS reimbursement rates are based on professional work, practice expense, and malpractice components) and payment reductions will apply for any other therapy performed on the same day. For the additional procedures provided on the same day, the practice expense (i.e., support personnel time, supplies, equipment, and indirect costs) of each fee will be reduced by 50% (effective April 1, 2013) for Part B services in all settings. The professional work and malpractice expense components of the payment will not be affected. ASHA has developed three MPPR scenarios to illustrate how reductions are calculated.
Source: asha.org

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 Supplement Rates Updated Daily

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

DHS: Frequently Asked Questions Medical Assistance

Posted by:  :  Category: Medicare

The Medicare Savings Program (MSP) program consists of three programs, Qualified Medicare Beneficiaries (QMB), Specified Low-Income Medicare Beneficiaries (SLIB or SLMB) and Qualified Individuals-1 (QI-1). Persons who receive Medicare part A and meet certain financial guidelines are potentially eligible for MSP. For more information contact your local Family Community Resource Center (FCRC). For the office nearest you, please use the DHS Office Locator. Download an MSP application (pdf).
Source: il.us

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

Prescription Drug Coverage

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

2017 Medicare Part D Prescription Drug Plans: Overview by State

Choose your State from the list below for an overview of the Medicare Part D Prescription Drug Plans available in 2017. Select your state below or choose from one of these links to other tools available to review 2017 Medicare Part D Plans:
Source: q1medicare.com

Medicare Information and Plan Comparisons

Posted by:  :  Category: Medicare

While health care was not central to the 2016 Presidential campaign, the election’s outcome will be a major determining factor in the country’s future health care policy. A number of issues have garnered media attention, including the future of the Affordable Care Act (ACA), rising prescription drug costs, and the opioid epidemic.
Source: medicare.org

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

What’s in Store for Medicare’s Part B Premiums and Deductible in 2016, and Why?

The absence of a COLA affects the amount of the Medicare Part B premium charged to enrollees because it triggers the broader application of a provision in the Social Security law known as the hold-harmless provision. In a year where the Social Security COLA is insufficient to cover the amount of the Medicare Part B premium increase for an individual, the law prohibits an increase in the Part B premium that would result in a reduction in that individual’s monthly Social Security benefits from one year to the next. (For an example of how the hold-harmless provision works in a typical year with a Social Security COLA, see Appendix B.) The hold-harmless provision affects a different number of beneficiaries each year, depending on the level of their Social Security benefits, the size of the COLA, and the increase in the Medicare Part B premium. In years with no COLA, a majority of beneficiaries are protected by the hold-harmless provision.
Source: kff.org

Annual Statistical Supplement, 2011

d. Standard premium rate for voluntary enrollment by certain aged and disabled individuals not otherwise entitled to Hospital Insurance (HI). (Most individuals aged 65 and older and many disabled individuals under age 65 are insured for HI benefits without payment of any premium.) Beginning in 1994, a reduced premium is available to premium-paying HI enrollees with at least 30 quarters of Medicare-covered employment (either their own or through a current or former spouse if the marriage meets certain duration criteria). In most cases, a surcharge applies for beneficiaries who enroll after their initial enrollment period.
Source: ssa.gov

Medicare Part B Enrollment When Working Beyond 65

By law, people who continue to work beyond age 65 still must be offered the same health insurance benefits (for themselves and their dependents) as younger people working for the same employer. So your employer cannot require you to take Medicare when you turn 65 or offer you a different kind of insurance — for example, by paying the premiums for Medicare supplemental insurance or a Medicare Advantage plan — as an inducement to enroll in Medicare and drop your employer plan. However, the law (known as ERISA) applies only to employers with 20 or more workers.  So if you work for a smaller business or organization, you may be required to enroll in Part B at age 65. Do I need to do anything about Part B at age 65 if I continue to be insured at work? It depends on whether you’re already receiving Social Security retirement benefits.  If you are, Social Security will automatically enroll you in Part A and Part B just before your 65th birthday.  The letter sent to you with your Medicare card explains your right to opt out of Part B if you have employer insurance.  To opt out, follow the instructions included in that letter within the specified deadline.
Source: aarp.org