Find and compare Home Health Agencies

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Source: medicare.gov

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

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Source: medicare.gov

Home Health Agency (HHA) Center

The Centers for Medicare & Medicaid Services (CMS) released a final rule (CMS-3819-F) that modernizes the Home Health Agency Conditions of Participation (CoPs). The final rule, effective July 13, 2017, will improve the quality of health care services for all home health patients and strengthen patients’ rights. The regulation reflects the most current home health agency practices by focusing on the care provided to patients and the impact of that care on patient outcomes. This regulation focuses on assuring the protection and promotion of patient rights; enhances the process for care planning, delivery, and coordination of services; and builds a foundation for ongoing, data-driven, agency-wide quality improvement. These changes are an integral part of CMS’ overall effort to improve the quality of care furnished through the Medicare and Medicaid programs, while streamlining requirements for providers. HHA (CoP) Final Rule (CMS-3819-F) at Federal Register through 1/12/2017
Source: cms.gov

Joining a health or drug plan

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Source: medicare.gov

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

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Source: medicare.gov

Medicare Open Enrollment 2014 & 2015 Information

[1] Insurance providers are not required to sell Medigap coverage to people who don’t sign up when they’re first eligible based on age or disability. They can make an exception for people who meet underwriting requirements, but your coverage may be more expensive if you buy a Medigap policy outside of your initial enrollment period.
Source: medicare.net

Medicare Open Enrollment: Are you ready to pick a plan?

Future health care needs can be hard to predict, but changes happen. Make sure you understand what services and benefits you’re likely to use in the coming year and find coverage that meets your needs. If you have other types of health or prescription drug coverage, make sure you understand how that coverage works with Medicare. And, if you travel a lot, look to see if your plan covers you when you’re away from home.
Source: medicare.gov

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

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Source: medicare.gov

Medicare enrolment application form (3101)

This information was printed Thursday 20 April 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

Ohio Medicaid, Health Insurance Marketplace Plans | Buckeye Health Plan

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Children in Custody/Foster Care: Beginning January 1, 2017, children in custody of the local Public Children Services Agency (PCSA) will be required to receive their Medicaid benefits through a Managed Care Plan (MCP). Read more…
Source: buckeyehealthplan.com

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

Posted by:  :  Category: Medicare

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Source: medicare.gov

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

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

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

List of Medicare Supplement Insurance Companies

This section provides a summary listing of all medicare supplement insurance policy plans (A, B, C, D, F, High Deductible F, G, K, L, M, N) that are available by the respective company. The report lists the companies that offer medicare supplement insurance policy plans for individuals under 65 years of age and over 65, along with the company’s reported comments (restrictions) and consumer contact information (i.e. consumer service phone number, customer service email, and web address). 
Source: ca.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

A Guide to Medicare Supplemental Companies

Christian Fidelity Life Insurance Company was established in 1954 and specializes in Phoenix, AZ providing life and health insurance coverage to the senior citizens. The company is located in and functions as a subsidiary of Oxford Life Insurance Organization. Christian Fidelity Life is actually a superb quality Final Expense Life Insurance and Medicare Supplement dispensing insurance company with excellent sales workforce, outstanding service and highly competitive premiums. Presently, about 30,000 insured persons being offered individual Supplemental Medicare insurance products. The company owns assets worth $90,802,891, a capital equaling $3,630,000 and a net surplus amounting to $41,934,621. Christian Fidelity Life Insurance Company has been graded with B++ (GOOD) rating. The two main insurance products provided by Christian Fidelity Life are Medicare Supplement and Life Insurance. The Supplemental Medicare plans offered by the company helps in covering the expenses left behind by Medicare, for example: Medicare Part A deductibles & co-payments, doctor services, outpatient services & supplies, emergency health care (outside U.S.), ambulance services, skilled nursing facility, speech therapy and extended hospital care. The other main type of insurance, provided by Christian Life is Life Insurance with a special whole life insurance plan known as Assurance Final Expense. This whole life policy is offered to the individuals aged from 50 to 85 years. The policy gives coverage for the funeral costs and other expenses when the insured person passes away.
Source: bestmedicaresupplement.com

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

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Source: medicare.gov

Medicare Supplement Plans F and G

Plans F and G are the only Medicare Supplement insurance plans that cover costs known as Medicare Part B excess charges. An excess charge is the difference between what a doctor or provider charges and the amount Medicare will pay. These plans will help protect you from additional out-of-pocket expenses should you need treatment that exceeds what Medicare will approve. Plan F also has a high-deductible option*. Plans F and G cover 100% of the Medicare Part B excess charges.
Source: humana.com

How to compare Medigap policies

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Source: medicare.gov

Medicare Supplement Plan F

Medicare Supplement Plan F is generally regarded as the most comprehensive plan out of the 10 Medicare Supplement (Medigap) policies available in most states. Its extensive coverage makes this a popular plan for beneficiaries who want broader assistance with out-of-pocket costs in Original Medicare; however, this also means that premiums may be more expensive. Because Plan F covers most remaining hospital and doctor costs after Original Medicare (Part A and Part B) has paid its share, it’s possible for beneficiaries with this plan to not have any or minimal other hospital and medical expenses.
Source: ehealthinsurance.com

How to Qualify For Medicaid and CHIP Health Care Coverage

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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

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

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

Coverage gap, also known as the “donut hole”: Not everyone will reach this phase; it begins if you and your plan spend a combined $3,700 in 2017 as described above. While in the coverage gap, you’ll typically pay 40% of the plan’s cost for brand-name drugs and 51% of the plan’s cost for generic drugs in 2017. You’re out of the coverage gap once your yearly out-of-pocket drug costs reach $4,950 in 2017. 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

Donut Hole, Medicare Prescription Drug

Most plans with Medicare prescription drug coverage (Part D) have a coverage gap (called a “donut hole”). This means that after you and your drug plan have spent a certain amount of money for covered drugs, you have to pay all costs out-of-pocket for your prescriptions up to a yearly limit. Once you have spent up to the yearly limit, your coverage gap ends and your drug plan helps pay for covered drugs again.
Source: healthcare.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

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

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Source: medicare.gov

How Medicare Advantage Plans work

Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by private companies approved by Medicare. If you join a Medicare Advantage Plan, you still have Medicare. You’ll get your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage from the Medicare Advantage Plan and not Original Medicare.
Source: medicare.gov

Obama administration budget proposes cuts for Medicare Advantage

Unlike standard Medicare, in which doctors and hospitals bill for each service they provide, private Medicare Advantage plans and other managed care organizations are often paid a flat monthly rate for each patient using a formula called a “risk score” that estimates the health challenges facing individual patients.
Source: publicintegrity.org

Cuts could be in store for Medicare Advantage plans

The plans have become a key source of revenue growth for insurers who sell and administer the subsidized coverage. They offer basic Medicare coverage topped with extras like vision or dental coverage or premiums lower than standard Medicare rates. There are hundreds of different plans around the country, each with its own set of variables like different deductibles, premiums and co-insurance.
Source: foxnews.com

Medicare Advantage Under the ACA: Replace Payment Cuts with Market

Use market-based bids for benchmark payments. Congress should delink benchmark payments from FFS and instead base payment solely on the bids that MA plans submit to the CMS to provide the traditional Medicare benefit (Parts A and B) to MA beneficiaries. There are a variety of ways to do this. For example, the new MA benchmark payment could be based on the weighted average bid of all plans in each county.[46] Under this method, each bid would be weighted by the proportion of beneficiaries enrolled in that plan in the preceding year. The benchmark payment could also be set at the levels proposed under various premium support proposals, such as the second-lowest cost plan[47] or the average of the three lowest-cost plan bids.[48] Bids would reflect the cost of providing benefits for a beneficiary in average health, and insurers would receive larger or smaller risk-adjusted payments from the government if an enrollee’s health was worse or better than average. If a plan were to bid higher than the benchmark payment, enrollees would pay the difference through increased premiums. If a plan were to bid below the benchmark payment, enrollees would receive the difference in a plan rebate.
Source: heritage.org

Report: Proposed Cuts to Medicare Advantage Would Increase Costs, Decrease Choice for Seniors

“CMS proposed to modify the Employer Group Waiver Plans bidding process to provide these plans with a fair benchmark, reflective of comparable local Medicare Advantage trends and prices,” a Centers for Medicare and Medicaid Services spokesperson said. “This proposal addresses the fact that Employer Group Waiver Plans do not compete against other Medicare Advantage plans to serve a particular population.”
Source: freebeacon.com