Some experts on
One response has been to propose that
Hospitals have been known to bill for services after a
A recent study by the Kaiser Family Foundation showed that increasing out-of-pocket expenses for
There is extensive debate over what the government can’t afford, but some of the reasons for the shortfall may be surprising. According to David Cay Johnston who reported on the tax system for the New York Times, the trend for U.S. companies to drastically reduce their tax bills by incorporating in Bermuda has been growing. Johnston, who won a Pulitzer Prize for his coverage of our tax system, points out that our laws don’t prevent this. He reported on a New Jersey industrial manufacturer that incorporated in Bermuda for $27,000 and could avoid at least $40 million in U.S. corporate income taxes. The company didn’t even need to maintain a Bermuda office. A mail drop there was sufficient to save them $40 million or more.
While our policymakers are still debating over what to do with Medigap Plans, you can take measures to reduce your out-of-pocket costs for health care.
The more you work to improve your
How you fuel your body is even more important than staying active. For starters, fruits and vegetables fight cancer, high blood pressure, and help you to maintain a healthy weight. Avoiding preventable disease does more than cut your cost for health care. It also makes it easier to navigate between
No matter how you look at it, investing in ways to protect your health is a money saver. Perhaps that’s why some
You have options of not paying the deductible and coinsurance that are part of Original
The IEP (Initial Enrollment Period) is still available for those who are just turning 65 and thus are aging in. If you have dual eligibility, that is, if you are entitled to
If you are in an Employer-sponsored plans and are considering joining a
Some private plans also offer a SNP designed to address identified needs of a targeted population for three verifiable chronic conditions: hypertension, high cholesterol, and diabetes. If you have at least one of these conditions, you are eligible to enroll in this plan during the SEP.
There is one more policy apart from the twelve plans that comes under Medigap policy. It is called
There are twelve plans under Medigap policy. Out of these twelve E, H, I, and J are terminated from June 1, 2010. There is also addition of two more plans. They are M and N. People insured under the terminated plans will have their policies renewed without any changes in the coverage. The
When you finally qualify for
You finally have a chance to set yourself up in a situation where you can totally predict your medical costs for the year. No surprises, no medical bills. Yet this time for a lot of folks is filled with stress. Piles and piles of mail, hundreds of emails and phone calls. This from agents and brokers looking for your business.
Then you have the people you actually know. Your brother-in-law who retired last year telling you what he did and why you should do the same thing. Your neighbor who can’t tell you enough how happy she is with her
The bottom line is that this is your open enrollment period and you only get one! One open enrollment period in your entire life. You have very special rights during this time. You have what are called Guaranteed Issue Rights. This means that during this time you can not be denied coverage for any plan that you choose. It does not matter what your past medical history is. You do not have to answer any health questions at all. Just pick the plan that is right for you and apply. These rights last until 6 months after your 65th birthday or your Part B effective date. Even if you are in great heath now, we know that unfortunately may not always be true. It would be tragic to not get the facts, make a choice that you regret and then not be able to rectify the situation because you can’t qualify health-wise.
So please, find an Independent Broker. One who specializes in
Please don’t just throw your hands up and say it’s too much, too confusing. Don’t do what your best friend, neighbor or your brother-in law did. Your circumstances are unique to you. Seek the help you need from a licensed professional. It is far too important. Believe me the decisions that you make during your
Making sense of Part D Medicare can be frustrating, but in this article, I will attempt to make it simple by answering some frequently asked questions about Medicare Part D.
First, what is Medicare Part D? When I was first learning about Medicare, the way I would remember Part D, is that Part D stands for “Drugs” (or more properly, prescription drugs). Part D is the part of Medicare that provides coverage for prescription medication.
1. Who is Eligible for Medicare Part D?
In order to get prescription drug coverage under Medicare, you must be eligible for Medicare Part A (hospital coverage) and enrolled in Part B (outpatient coverage). Most people are eligible for Medicare when they turn 65, or if they have been disabled for 24 months (receiving social security disability benefits).
When you become eligible for Medicare, you will also be eligible for Part D Medicare.
2. Is Part D Coverage Automatic?
No, you must enroll in Part D in order to receive the benefits. Some people choose to skip enrollment, because they are not taking many, or any prescription drugs. This however may be a mistake. If you do not enroll in Part D (an approved Medicare Drug Plan) when you are first eligible, you will be charged a penalty for every month you were not enrolled (1% per month in 2009-2010).
3. How Do I Enroll and Get Medicare Prescription Plans?
As of the writing of this article, Medicare Prescription Plans provided through private insurance companies, approved by Medicare. If you want prescription drug coverage, you must apply through an approved insurance company. You can think of it like getting a little insurance policy that only pays for your prescription medications (at least part of them anyway).
Some Medicare prescription drug plans work alone (they are called stand-alone prescription drug plans). Other drug plans are combined with a medical plan. Most often, these combined plans are HMO’s or PPO’s, combined which include prescription drug plans.
4. Are All Medicare Part D Plans the Same?
No, most Medicare Part D Plans do have some differences. One of the most obvious differences is the price. Just as you can “shop” for a better price for auto insurance or life insurance, you can also shop for a better price for your Medicare Plan D.
There is another important factor that you should think about though and that is what is called the “formulary.” A formulary is a list of approved drugs, along with a “tier” system that tells you how much the drugs will cost.
For example, the Super Duper Drug Plan (fictional) from Company ABC (also fictional), might charge $5.00 for tier one drugs (generics) and 60% for tier three drugs (slightly expensive name brands).
Every prescription drug plan has a different formulary, which is why one size rarely, if ever fits everybody (no matter what a movie star on a commercial might say about a particular company)!
5. What is this Donut Hole I Hear So Much About?
The donut hole, A.K.A. coverage gap is a bit complicated, but lets see if we can make it easy.
Imagine that there are three water tanks. The first two tanks have a watermark and the last tank has no mark.
In 2009, the watermark for the first tank was $2,700. Both you and your insurance company pour in your part of the water (dollars) until you reach the watermark together. After you reach the watermark, you move on to the second tank by yourself, without your insurance company to help you (the notorious donut hole).
In 2009, the watermark for the donut hole tank was $4,350. After you have spent a total of $4,350 out of your own pocket for the year, you will move on to the third tank.
At the third tank, your insurance company does most of the heavy lifting. You only put in a few dollars (like a $6 co-pay for your medications) and your insurance company puts in the rest with no limits.
6. What If I Cannot Afford My Prescription Drugs?
If you cannot afford to pay for your drug coverage, or your prescription drug coverage, you may be eligible for “extra help” to pay for what you need. To find out if you qualify for extra help, you can call your local social security office, Medicare (1-800-MEDICARE), or contact me at MedicareNational.com (we can help you find out if you qualify).
The new chief of
Lobbyists from the health care industry are trying to influence how it will be determined which physician groups and which hospitals will be included in the new program. Several northeast states are pushing to have its doctor groups be designated “accountable care organizations” which will entitle them to funding under the new program.
The government is working to fundamentally change the way it pays doctors and hospitals in the
With global payments, physicians will receive flat fees for managing a large number of patients, with financial incentives built in based on patient health and lowering the number of days patients stay in the hospital.
In some states, private insurance companies like Blue Cross and Blue Shield have started increasing global payments for diabetes care, high-blood pressure, and cardiovascular disease. State politicians charged with controlling health care costs, have been working on the decision of whether they should adopt new ideas like global payments.
“Among the lessons of Massachusetts is that you can’t sustain coverage reform without taking big steps on affordability,” said Andrew Dreyfus, chief executive of Blue Cross and Blue Shield of Massachusetts. “No one understands that better than Don.”
Berwick, who has been well admired by other health insurance policy experts, has several hurdles he will need to face while trying to implement his agenda in Washington. Republicans, specifically, have been upset that they were unable to use his confirmation to put up a fight about the new health insurance law.
Without the support of some Republican senators, Unless he can win over some GOP senators, who voted uniformly against the health care law, Berwick won’t be able to win a 60-vote confirmation in the Senate and will be forced to leave office when his recess appointment expires at the end of 2011.
Consumers interested in saving money through
Questions arise all the time about
The first group of people we will look into is the group of adults that are sixty-five and older. Sixty-five is a qualifying age however there are other requirements that must be met to receive
If you find you meet all three of these guidelines it is most likely that just prior to your sixty-fifth birthday you will receive a
If you are under sixty-five you can also qualify for
There are multiple items that
Acupuncture is a type of alternative medicine is not covered. Acupuncture is a treatment that works through the insertion of thin needles strategically placed throughout the body to help cure ailments.
Dental care is an incredibly important part of the aging process and is not part of
Chiropractic care is also something that many older people rely on that is not covered. Often time’s doctors of chiropractics will offer discounted rates to seniors. This is something to think about however when seeking out gap insurance if your doctor is not one that does.
Obviously the list of covered versus not covered is detailed in great lengths through handbooks, websites and pamphlets. Supplemental insurance providers are a great source of knowledge as they can review your past history with you and based on the pattern that has developed guide you into the right combination of plans. This way you are not purchasing additional coverage that is not ever going to be utilized.
Part C could also be referred to as the
In a PPO, one has the freedom to choose his/her own medical providers (doctors and specialists) out of the network. The beneficiary might have to pay out of network charges but has the freedom to see medical experts without referral.
Under this plan, one can either use the High Deductible Plan, which will not provide coverage until the mentioned amount of deductible is met. The other is that,
Here the beneficiary can see any doctor or specialist of choice without referral only if they concur with the terms, conditions and fees of the PFFS.
Each beneficiary has an HMO network and can choose hospital(s) and medical providers from that network alone. One might require a referral from his/her primary care physician in order to see a specialist.
This plan is usually for persons with special health needs and chronic illnesses. A special plan must include Part A, B and D too.
Most Part C plans should have Part D or prescription drug coverage, but if one already has a separate Part D plan then, s/he cannot buy a Part C plan with drug coverage. An individual will need to buy a Part C plan with no drug coverage.
Anyone who is eligible for
* You are qualified to apply for or are receiving benefits for railroad retirement.
* You’re qualified to apply for or are receiving Social Security benefits.
Unless you come under one of the examples outlined above, you might still receive
* You receive railroad benefits or perhaps you meet the criteria to get them.
* You are a sufferer of full kidney failure or receive dialysis maintenance and/or you had a renal system transplant.
* You suffer from Lou Gehrig’s condition.
* You meet particular criteria and have railroad retirement board authorized disability pension plan.
* You’ve gotten social security benefits (or are eligible) for more than two calendar years (24 months).
This is the basic summary of which individuals are qualified for
Part A – hospital insurance
Part B – medical insurance (this is optional)
Part C – additional insurance coverage
Part D – offers voluntary prescription drug coverage offered via private vendors
Part A is called hospital insurance. It covers most costs of your stay in the hospital as well as some follow-up costs after being in the hospital. It also pays some outpatient medical services, including medically necessary equipment and supplies, home health care, and physical therapy. Under most circumstances (if you’ve paid enough FICA taxes), you don’t have to pay a premium for Part A.
Part B is medical insurance. It’s optional. If you elect it, the monthly premium is deducted from your Social Security check automatically. It provides for certain out-of-hospital treatments and is intended to help pay doctor’s bills for treatment in or out of the hospital. It also covers many other medical expenses you incur when you’re not in the hospital, such as the costs of necessary medical equipment and tests.
1) health maintenance organizations (HMOs) and
2) preferred provider organizations (PPOs).
HMOs are generally less expensive than PPOs but usually more restrictive in their services and choice of doctors.
With these latter two plans in Part C, you must still continue to pay your Part B premiums, and you may also have to pay an additional premium to the insurance company as well as any related deductible or co-insurance payments. However, the services you receive may be more comprehensive than those offered through the Original
1. You can join one of the
2. Join a Medical Advantage Plan – like a Health Maintenance Organization (HMO) or a Preferred Provider Organization (PPO) or some other Medical health plan that includes prescription drug coverage.
In either category you’ll usually pay a separate monthly premium for the drug coverage in addition to your Part B premium.
After joining a specific MDP, the plan mails you membership materials including a card to use when you get your prescriptions filled. When you use the card, you may have to pay a copayment, coinsurance, or a deductible amount depending on your plan
What to consider when comparing which MDP to choose:
Look for the Coverage, Cost and Convenience to you from each plan. These will be different.
Coverage – check if the type of prescription you want comes under that plan.
Cost – see what costs and payment schedule that plan offers you.
Convenience – make sure the plan’s pharmacies include the ones you want to use.
You can switch your plan each your from November 15 to December 31.
If you’re on Medicaid, they’ll automatically enroll you in a MDP if you don’t join yourself. Under Medicaid, in most cases, you’ll pay from nothing to about $5.60 out-of-pocket for each covered drug.