Oklahoma Insurance Department

Posted by:  :  Category: Medicare

The Senior Health Insurance Counseling Program (SHIP) is a non-profit organization helping to inform the public about Medicare and other senior health insurance issues. This division provides accurate and objective counseling, assistance, and advocacy relating to Medicare, Medicaid, Medicare supplements, Medicare Advantage, long-term care, and other related health coverage plans for Medicare beneficiaries, their representatives, or persons soon to be eligible for Medicare.
Source: ok.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

Welcome To The Oklahoma Health Care Authority

Due to inclement weather, the Governor has authorized state agencies to reduce non-essential services as of 3:00PM CST on Tuesday, April 26th. As a result, OHCA will be closing at that time. Thank you for your patience and be safe.
Source: okhca.org

Oklahoma Insurance Department

Medicare is made up of Parts A, B, C & D. Most people over age 65 get Medicare Part A premium free but most must pay a monthly premium for Medicare Part B ($121.80 in 2016). A choice of how you take your Medicare is given with Medicare Part C (Medicare Advantage), and Part D gives the opportunity to purchase a prescription drug plan.
Source: ok.gov

Oklahoma and the ACA’s Medicaid expansion: eligibility, enrollment and benefits

Funding for Insure Oklahoma comes from tobacco taxes and matching federal funds that were scheduled to cease at the end of 2013 and be replaced with Medicaid expansion funding. But because Oklahoma did not accept Medicaid expansion, the state instead negotiated with the federal government to get a one year extension for Insure Oklahoma. The state got a second extension in June 2014 that allowed Insure Oklahoma to continue to operate throughout 2015, and a third extension in June 2015 provided continued federal funding through the end of 2016. In March 2016, Oklahoma submitted another waiver that would extend the Insure Oklahoma program through 2018, but as of October 1, 2016, approval from CMS was still pending.
Source: healthinsurance.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 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

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

Pay more and get less: The Ryan plan to privatize Medicare

The total cost of providing Medicare benefits to enrollees is expected to rise under the proposal, according to the CBO. This is because private plans have higher administrative costs and typically pay higher fees to providers than Medicare. While private plans may be able to achieve lower utilization through tighter cost and care management practices, the CBO believes the total costs of providing a similar benefit package would be higher under private plans than Medicare, and that the differential between the costs under traditional Medicare and the costs under private plans would widen over time. 
Source: dailykos.com

South Carolina Payroll :: Paycheck Calculator, South Carolina Payroll Taxes, Payroll Services, SC Salary Calculator

Posted by:  :  Category: Medicare

Free Paycheck Calculator to calculate net amount and payroll taxes from a gross paycheck amount. Paycheck Calculator is a great payroll calculation tool that can be used to compare net pay amounts (after payroll taxes) in different states. Some states have no income taxes (such as Alaska, Texas, Florida, Nevada, Washington), while other states (California, New York) have a high state income on employee earnings, resulting in smaller net paycheck amounts. Using the payroll calculator you can compare how your base salary translates into net earnings (after tax) in the state of your employment. In case of considering a job in a different state you can compare how much you will make after taxes in that state.
Source: payrollsouthcarolina.com

South Carolina Primary Health Care Association

SCPHCA is the unifying organization for Community Health Centers (CHCs) in SC. CHCs are community based non-profit organizations that provide access to quality comprehensive primary health care services to over 326,800 patients in SC.
Source: scphca.org

S.C. Department of Health & Environmental Control

Veterinarians across South Carolina will once again join forces with the Department of Health and Environmental Control this spring to help owners protect their pets, their families, their communities, and themselves against rabies. Find a clinic in your county.
Source: scdhec.gov

State of Oregon: Medicare Help

Posted by:  :  Category: Medicare

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Source: oregon.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

State of Oregon: Division of Financial Regulation

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Source: oregon.gov

Trillium Community Health Plans in Oregon

Trillium Community Health Plan will not be offering coverage for the Commercial/Exchange individual plans in the Marketplace for 2017. Please contact Trillium Member Services with any questions regarding plans previously offered in the Marketplace.
Source: trilliumchp.com

Medicare Dental in Los Angeles, California with Reviews

Posted by:  :  Category: Medicare

- helps you find the right local businesses to meet your specific needs. Search results are sorted by a combination of factors to give you a set of choices in response to your search criteria. These factors are similar to those you might use to determine which business to select from a local Yellow Pages directory, including proximity to where you are searching, expertise in the specific services or products you need, and comprehensive business information to help evaluate a business’s suitability for you. “Preferred” listings, or those with featured website buttons, indicate YP advertisers who directly provide information about their businesses to help consumers make more informed buying decisions. YP advertisers receive higher placement in the default ordering of search results and may appear in sponsored listings on the top, side, or bottom of the search results page.
Source: yellowpages.com

Best Medicaid Office in San Fernando, California with Reviews

- helps you find the right local businesses to meet your specific needs. Search results are sorted by a combination of factors to give you a set of choices in response to your search criteria. These factors are similar to those you might use to determine which business to select from a local Yellow Pages directory, including proximity to where you are searching, expertise in the specific services or products you need, and comprehensive business information to help evaluate a business’s suitability for you. “Preferred” listings, or those with featured website buttons, indicate YP advertisers who directly provide information about their businesses to help consumers make more informed buying decisions. YP advertisers receive higher placement in the default ordering of search results and may appear in sponsored listings on the top, side, or bottom of the search results page.
Source: yellowpages.com

California CA Medicaid Dentist Public Dental Health Provider

Finding an approved dentist in your immediate area can be difficult or frustrating. In general terms, smaller cities have few provider resources that can include general dentists or practices and a variety of specialties. Orthodontists are also listed in a directory at Medicaid Orthodontist.com. The specialty of oral surgery may best be found by finding general dentistry practices that are already enrolled providers. If oral surgery is not available with a particular practice, a referral may be possible from that office. Endodontists (root canal specialists) may also be similarly found. Medicaid recipients may discover they will need to travel to another county or city to find approved practices. Dentists who accept medicaid payment programs for childrens dentistry can be found through the use of a family dental practice that provides general dental care patient of all ages or through Pediatric specialists that are listed, in part, in this directory.
Source: medicaiddentistry.com

Medicare Dentists in Orange County, CA: Book Appointments Online

“The dentist was excellent, but I waited for an an hour and fifteen minutes to be seen. I understand that these things happen, but that doesn’t make it acceptable, and a better practice of mutual respect could be for an office to give patients a heads up before or at the very least when they arrive so that we might adjust our own plans accordingly.”
Source: zocdoc.com

Medicaid Dentists in Los Angeles, CA: Reviews & Ratings

“The dentist was excellent, but I waited for an an hour and fifteen minutes to be seen. I understand that these things happen, but that doesn’t make it acceptable, and a better practice of mutual respect could be for an office to give patients a heads up before or at the very least when they arrive so that we might adjust our own plans accordingly.”
Source: zocdoc.com

Costs in the coverage gap

Posted by:  :  Category: Medicare

If you think you’ve reached the coverage gap and you don’t get a discount when you pay for your brand-name prescription, review your next “Explanation of Benefits” (EOB). If the discount doesn’t appear on the EOB, contact your drug plan to make sure that your prescription records are correct and up-to-date. Get your plan’s contact information from a Personalized Search (under General Search), or search by plan name. If your drug plan doesn’t agree that you’re owed a discount, you can file an appeal.
Source: medicare.gov

What’s Medicare Supplement Insurance (Medigap)?

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

The Medicare Part D Coverage Gap (“Donut Hole”) 

Coverage gap, also known as the “donut hole”: While in the coverage gap, you’ll pay 45% of the plan’s cost for brand-name drugs and 58% of the plan’s cost for generic drugs in 2016. You’re out of the coverage gap once your yearly out-of-pocket drug costs reach $4,850 in 2016. Once you have spent this amount, you’ve entered the catastrophic coverage phase. The costs paid by you or someone on your behalf (such as a spouse or loved one) for Part D medications on your plan’s formulary, or list of covered drugs, will count toward your out-of-pocket costs and help you get out of the coverage gap* Additionally, manufacturer discounts for brand-name drugs count towards reaching the spending limit that begins catastrophic coverage. If your plan requires you to get your prescription drugs from a participating pharmacy, make sure you do so, or else the costs may not apply towards getting out of the coverage gap. Keep in mind that costs that are paid for you by other insurance you may have, such as prescription drug coverage through an employer, won’t count towards your out-of-pocket spending.
Source: medicare.com

Medicare Part D coverage gap

The Medicare Part D coverage gap (informally known as the Medicare donut hole) is a period of consumer payment for prescription medication costs which lies between the initial coverage limit and the catastrophic-coverage threshold, when the consumer is a member of a Medicare Part D prescription-drug program administered by the United States federal government. The gap is reached after shared insurer payment – consumer payment for all covered prescription drugs reaches a government-set amount, and is left only after the consumer has paid full, unshared costs of an additional amount for the same prescriptions. Upon entering the gap, the prescription payments to date are re-set to $0 and continue until the maximum amount of the gap is reached: copayments made by the consumer up to the point of entering the gap are specifically not counted toward payment of the costs accruing while in the gap.
Source: wikipedia.org

About the Medicare Part D Coverage Gap

The Medicare coverage gap is the phase of your Medicare Part D benefit when there is a gap in prescription drug coverage. During this phase, you will have to pay more for your drugs, until you reach the catastrophic coverage phase. Most Medicare Advantage Prescription Drug plans and Medicare Prescription Drug Plans have a coverage gap, or “donut hole.” The coverage gap is reached when your total drug costs (what you and your plan pay) reach a certain amount. You then pay for your prescriptions out of pocket until entering the plan’s catastrophic coverage phase. This is when your total out-of-pocket costs, including the annual deductible and copayments/coinsurance, reach $4,850 in 2016.
Source: medicare.com

Medicare: What Are Medigap Plans?

However, you may have to wait up to six months for coverage if you have a pre-existing health condition. The insurer through which you buy your Medigap policy can refuse to cover out-of-pocket costs for pre-existing conditions during that period. After six months, the Medigap policy must cover the pre-existing condition. The exception to this rule is if you buy a Medigap policy during your open enrollment period and have had continuous “creditable coverage,” or a health insurance policy for the six months before buying a policy. The Medigap insurance company cannot withhold coverage for a pre-existing condition in that case.
Source: webmd.com

Part D Information for Pharmaceutical Manufacturers

The Medicare Coverage Gap Discount Program (Discount Program) makes manufacturer discounts available to eligible Medicare beneficiaries receiving applicable, covered Part D drugs, while in the coverage gap. In order to participate in the Discount Program, manufacturers must sign an agreement with CMS to provide the discount on all of its applicable drugs (i.e. prescription drugs approved or licensed under new drug applications or biologic license applications). Beginning in 2011, only those applicable drugs that are covered under a signed manufacturer agreement with CMS can be covered under Part D.
Source: cms.gov

Medicare Part D Donut Hole – Prescription Drug Coverage Gap

Most Medicare Part D Prescription Drug Plans have a coverage gap, sometimes called the Medicare “donut hole.” This means that after you and your Medicare drug plan have spent a certain amount of money for covered prescription drugs, you then have to pay all costs out-of-pocket for the drugs, up to a certain out-of-pocket limit. The yearly deductible, coinsurance, or copayments, and what you pay while in the coverage gap, all count toward this out-of-pocket limit. The limit doesn’t include the drug plan’s premium.
Source: ehealthmedicare.com

Get Medicare Part D Quotes in Seconds

Posted by:  :  Category: Medicare

As could be expected, prices for Humana policies rocketed for the 2015 calendar year. Mean premiums for Humana Part D jumped from $21.80 to $38.70. Medicare Part D is priced at $41.55 and Part D Medicare comes in at the slightly lower price of $38.80. Humana’s standalone market share coverage has dropped to 18.6% whereas their Medicare Part D policies have increased to a market share of 12.8%.
Source: medicareaide.com

Medicare Part D coverage gap

The Medicare Part D coverage gap (informally known as the Medicare donut hole) is a period of consumer payment for prescription medication costs which lies between the initial coverage limit and the catastrophic-coverage threshold, when the consumer is a member of a Medicare Part D prescription-drug program administered by the United States federal government. The gap is reached after shared insurer payment – consumer payment for all covered prescription drugs reaches a government-set amount, and is left only after the consumer has paid full, unshared costs of an additional amount for the same prescriptions. Upon entering the gap, the prescription payments to date are re-set to $0 and continue until the maximum amount of the gap is reached: copayments made by the consumer up to the point of entering the gap are specifically not counted toward payment of the costs accruing while in the gap.
Source: wikipedia.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

Medicare Part D Prescription Drug Plans

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Source: cigna.com

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 Information and Plan Comparisons

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 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

Covered and Excluded Drugs in the Medicare Part D Drug Formulary

Medicare Prescription Drug Plans are available from private insurance companies contracted with Medicare to provide and coordinate prescription benefits to beneficiaries. As a Medicare beneficiary, there are two ways for you to get prescription drug coverage (Medicare Part D): through a stand-alone Medicare Prescription Drug Plan, if you have Original Medicare, or through a Medicare Advantage Prescription Drug plan. Because these plans are offered through Medicare-approved private insurance companies, this basically means that each Medicare Prescription Drug Plan will provide different types of prescription drug coverage. It’s the insurance company that ultimately decides which drugs to cover under its prescription drug plan and at what benefit level.
Source: ehealthmedicare.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

Understanding Medicare, Getting Started

• Parts A and B are often referred to as Original, or Traditional, Medicare. Part A helps pay your hospital bills, and most people have paid for their Part A premiums through payroll taxes while working. Part B helps pay for doctor visits and other medical services, including screenings for heart disease, diabetes and some types of cancer. • Part C plans, also known as Medicare Advantage plans, are Medicare-approved plans offered by private insurance companies. Part C plans are an alternative to Original Medicare. Along with covering doctors and hospitals, they often cover prescription drugs, too. • Part D plans are Medicare-approved private plans that help people who have Parts A and B to pay for prescription drugs.
Source: aarp.org

Medicare Information and Guidance On Costs, Coverage

3. Do enroll when you’re supposed to: To avoid permanent late penalties, enroll at age 65 if you don’t have insurance from an employer for whom you or your spouse is still working or if you live abroad without working; or, beyond 65, enroll within eight months of stopping work — even if you continue to receive COBRA or retiree health benefits from an employer.
Source: aarp.org

Medicare Flu Shot Codes: Q2035, Q2036, Q2037, Q2038

The Centers for Medicare & Medicaid Services (CMS) no longer recognizes and does not reimburse CPT Code 90658 Influenza Virus Vaccine, Split Virus for flu shots. CMS has established six separate influenza vaccine HCPCS codes to distinguish between the brand-names of influenza vaccines for governmental tracking purposes. Make sure to use these new codes in your medical billing.
Source: capturebilling.com