Ross Blair
President and CEO, eHealth Medicare
Ross Blair is the founder and Chief Executive Officer of eHealthMedicare.com, a website that makes it easier for seniors and their caregivers to select and enroll in the best Medicare products for their specific needs.
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Question
Mom has Medicare Supplement Plan F, would Medigap Plan G save her money?
Hi Tina, You're comparing two different things here, so be careful. Medicare has three Parts - Part A, Part B and Part D Parts A&B... Hi Tina,
You're comparing two different things here, so be careful.
Medicare has three Parts - Part A, Part B and Part D
Parts A&B are your medical coverage and Part D is your drug coverage.
Medicare Supplement Plans - MedSup - fill the gaps in Original Medicare (Parts A&B).
So, whether you have Supplement Plan F or Supplement Plan G will not impact what she pays for prescription drugs.
I'll come back to drug costs in a second, but when it comes to switching MedSup plans know this:
1. Plan F is generally considered the "cadillac" of MedSup plans. It provides the most coverage the with lowest out-of-pocket costs to you. But, the monthly premiums tend to be higher.
2. You cannot always switch a MedSup plan. Outside of your initial enrollment period when you first sign up for Medicare, the MedSup plans can be underwritten and your application can be declined. This is not ALWAYS the case. It can vary state by state and from insurer to insurer, so call a licensed expert and find out what your options are before you switch.
DRUG COVERAGE:
If your mom is on MedSup, she should also have a stand-alone prescription drug plan (Part D coverage).
She can change he drug coverage every year during the Annual Election Period or AEP (which starts today and runs through December 7).
We strongly encourage people to use AEP to do a comparison search for drug coverage. The plan prices and co-pays for each individual drug and dose change every year.
We publish a study each year looking at what the average person saves by comparing plans and prices and last year it averaged out to over $600 a year.
If you compare drug plans please have the following avaiable:
1. The name of the drug plan your mom is on
2. The names of the drugs she's taking
3. The dosages of the drugs she's taking
4. The name of the pharmacy she uses
All of these factors can change her out of pocket costs for drugs. Once you have all of that, you can go to PlanPrescriber.com, eHealthMedicare.com or Medicare.gov and out-of-pocket costs for her drug regimen side-by-side to find the lowest cost plan.
I like our sites eHealthMedicare and PlanPrescriber if you're not a Medicare expert. We spend a lot of time making them easy to use, but Medicare.gov is also good. see more
You're comparing two different things here, so be careful.
Medicare has three Parts - Part A, Part B and Part D
Parts A&B are your medical coverage and Part D is your drug coverage.
Medicare Supplement Plans - MedSup - fill the gaps in Original Medicare (Parts A&B).
So, whether you have Supplement Plan F or Supplement Plan G will not impact what she pays for prescription drugs.
I'll come back to drug costs in a second, but when it comes to switching MedSup plans know this:
1. Plan F is generally considered the "cadillac" of MedSup plans. It provides the most coverage the with lowest out-of-pocket costs to you. But, the monthly premiums tend to be higher.
2. You cannot always switch a MedSup plan. Outside of your initial enrollment period when you first sign up for Medicare, the MedSup plans can be underwritten and your application can be declined. This is not ALWAYS the case. It can vary state by state and from insurer to insurer, so call a licensed expert and find out what your options are before you switch.
DRUG COVERAGE:
If your mom is on MedSup, she should also have a stand-alone prescription drug plan (Part D coverage).
She can change he drug coverage every year during the Annual Election Period or AEP (which starts today and runs through December 7).
We strongly encourage people to use AEP to do a comparison search for drug coverage. The plan prices and co-pays for each individual drug and dose change every year.
We publish a study each year looking at what the average person saves by comparing plans and prices and last year it averaged out to over $600 a year.
If you compare drug plans please have the following avaiable:
1. The name of the drug plan your mom is on
2. The names of the drugs she's taking
3. The dosages of the drugs she's taking
4. The name of the pharmacy she uses
All of these factors can change her out of pocket costs for drugs. Once you have all of that, you can go to PlanPrescriber.com, eHealthMedicare.com or Medicare.gov and out-of-pocket costs for her drug regimen side-by-side to find the lowest cost plan.
I like our sites eHealthMedicare and PlanPrescriber if you're not a Medicare expert. We spend a lot of time making them easy to use, but Medicare.gov is also good. see more
Question
Can my grandfather (92) with bone cancer get Medicare part A (he has B) before the enrollment period?
Hi Morgie, There are a few reasons why person may not have Medicare Part A. For example, we've worked with people who have not worked... Hi Morgie,
There are a few reasons why person may not have Medicare Part A. For example, we've worked with people who have not worked 40 quarters or 10 years in a job where they paid payroll taxes into the Medicare system.
Other issues we've seen are related to the Medicare system where-in Medicare does not “grant” Medicare Part A due to citizenship or some other entitlement issues.
If these issues are present when you become eligible for Medicare, you can purchase Medicare Part A for a monthly premium at that time, but auto enrollment does not happen.
I would strongly encourage you to call 1 800-Medicare to get some additional information of what happened with Part A. Once you find out, they can direct you toward alternatives. You can also always give us a call at eHealthMedicare at 1-877-543-6609 / TTY User 711 see more
There are a few reasons why person may not have Medicare Part A. For example, we've worked with people who have not worked 40 quarters or 10 years in a job where they paid payroll taxes into the Medicare system.
Other issues we've seen are related to the Medicare system where-in Medicare does not “grant” Medicare Part A due to citizenship or some other entitlement issues.
If these issues are present when you become eligible for Medicare, you can purchase Medicare Part A for a monthly premium at that time, but auto enrollment does not happen.
I would strongly encourage you to call 1 800-Medicare to get some additional information of what happened with Part A. Once you find out, they can direct you toward alternatives. You can also always give us a call at eHealthMedicare at 1-877-543-6609 / TTY User 711 see more
Question
Blue cross 65, how can one figure out what is covered and not?
Hi Slad, There are not a lot of specifics in your question here, but let me encourage you to do a couple of things. 1. Review our Medicare... Hi Slad,
There are not a lot of specifics in your question here, but let me encourage you to do a couple of things.
1. Review our Medicare Resource Guide, which will give you some good basic information, and its not as long as War and Peace: http://news.ehealthinsurance.com/_ir/68/20125/2013_Medicare_Resource_Guide.pdf
2. If you have specific questions about what to enroll in or what medical services are covered, I'd also encourage you to contact a licensed agent. You are under zero obligation to enroll in anything or buy anything when you work with an agent, and they can give you specific information about what Medicare covers, what it doesn't cover and what supplemental products are available to fill the gaps.
1-877-543-6609 / TTY User 711 see more
There are not a lot of specifics in your question here, but let me encourage you to do a couple of things.
1. Review our Medicare Resource Guide, which will give you some good basic information, and its not as long as War and Peace: http://news.ehealthinsurance.com/_ir/68/20125/2013_Medicare_Resource_Guide.pdf
2. If you have specific questions about what to enroll in or what medical services are covered, I'd also encourage you to contact a licensed agent. You are under zero obligation to enroll in anything or buy anything when you work with an agent, and they can give you specific information about what Medicare covers, what it doesn't cover and what supplemental products are available to fill the gaps.
1-877-543-6609 / TTY User 711 see more
Question
Will ObamaCare pay for my Medicare insurance supplement?
Hi Dee, The Affordable Care Act does not provide an alternative to Medicare. Given your income, I would encourage you to contact an expert... Hi Dee, The Affordable Care Act does not provide an alternative to Medicare. Given your income, I would encourage you to contact an expert - either one of our agents at eHealthMedicare, social security or contact Medicare directly at 1-800-MEDICARE to see if you qualify for dual eligibility, which is a combination of Medicare and Medicaid. see more
Question
Will Medicare (Part B) withdraw moms coverage in nursing home if we try to pay for difference of private room...
This is a difficult question to answer because the type of insurance the beneficiary has is unknown. If the individual has an MAPD or Med... This is a difficult question to answer because the type of insurance the beneficiary has is unknown. If the individual has an MAPD or Med Supplement health plan, they should call the health plan’s member service department to inquire how the insurance company would bill for the Medicare allowed amount (semi-private room) versus a private room. This is a question the nursing home should be able to facilitate based on the type of insurance the beneficiary has.
If the beneficiary has Original Medicare, they can call 1-800-MEDICARE to find out how Medicare would bill for the non-Medicare covered private room. Medicare Part A is "Hospital Insurance” which helps cover inpatient care in hospitals and skilled nursing facilities. Medicare Part B covers Medical and other services such as physician services.
Original Medicare Benefit:
Days 1–20: $0 each day.
Days 21–100: up to $144.50 each day.
Beyond 100 days: all costs.
There’s a limit of 100 days of Medicare Part A SNF coverage in each benefit period.
The beneficiary may also be expressing a concerned regarding a quality of care issue with the nursing home. Has the family talked to the nursing home about moving their mother to another room or a different area of the nursing home? The patient has resident rights under Medicare: including the right to be treated with dignity and respect; being informed in writing about services and fees before entering the nursing home. see more
If the beneficiary has Original Medicare, they can call 1-800-MEDICARE to find out how Medicare would bill for the non-Medicare covered private room. Medicare Part A is "Hospital Insurance” which helps cover inpatient care in hospitals and skilled nursing facilities. Medicare Part B covers Medical and other services such as physician services.
Original Medicare Benefit:
Days 1–20: $0 each day.
Days 21–100: up to $144.50 each day.
Beyond 100 days: all costs.
There’s a limit of 100 days of Medicare Part A SNF coverage in each benefit period.
The beneficiary may also be expressing a concerned regarding a quality of care issue with the nursing home. Has the family talked to the nursing home about moving their mother to another room or a different area of the nursing home? The patient has resident rights under Medicare: including the right to be treated with dignity and respect; being informed in writing about services and fees before entering the nursing home. see more
Question
Group health insurance for caregivers?
Hi GladImHere - If you meet certain criteria, you may be eligible for coverage under the Health Insurance Portability and Accountability... Hi GladImHere -
If you meet certain criteria, you may be eligible for coverage under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). This may give you access to similar health plans at a slightly higher cost, but without medical underwriting or pre-existing condition waiting periods. Someone who is eligible for HIPAA must meet all of the following criteria:
1. Have elected and exhausted health insurance benefits through a COBRA or similar group, state, or federal continuation. This would include the Federal Employee Health Benefits Program (FEHBP), FEHBP Temporary Continuation of Coverage (TCC), or state continuation coverage, if available.
2. Have 18 months of creditable coverage with the most recent coverage under an employer-sponsored plan, governmental plan, church plan, or a health benefit plan offered in conjunction with any of these plans. Certificates of creditable coverage must indicate at least 18 months of aggregate health insurance coverage.
3. Have no more than a 62-day break in coverage.
4. Be ineligible for Medicare A or B, Medicaid, or any other employer-sponsored plan.
5. Not be covered by any other health insurance plan.
6. Not have had prior coverage terminated because of failure to pay the required premium or because you committed fraud.
Al that being said, if you're in relatively good health you may find health insurance for less.
Go online to eHealthInsurance.com. Put in your zip code, date of birth and gender (that's all) and you should see dozens of plans available from name-brand insurance companies designed specifically for people under the age of 65.
If you find something that might work for you, pick up the phone and call one of their agents. Chat, and see what they can do for you. You should know that if you have a pre-existing condition, the HIPPA plan (though expensive) may be your only option. see more
If you meet certain criteria, you may be eligible for coverage under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). This may give you access to similar health plans at a slightly higher cost, but without medical underwriting or pre-existing condition waiting periods. Someone who is eligible for HIPAA must meet all of the following criteria:
1. Have elected and exhausted health insurance benefits through a COBRA or similar group, state, or federal continuation. This would include the Federal Employee Health Benefits Program (FEHBP), FEHBP Temporary Continuation of Coverage (TCC), or state continuation coverage, if available.
2. Have 18 months of creditable coverage with the most recent coverage under an employer-sponsored plan, governmental plan, church plan, or a health benefit plan offered in conjunction with any of these plans. Certificates of creditable coverage must indicate at least 18 months of aggregate health insurance coverage.
3. Have no more than a 62-day break in coverage.
4. Be ineligible for Medicare A or B, Medicaid, or any other employer-sponsored plan.
5. Not be covered by any other health insurance plan.
6. Not have had prior coverage terminated because of failure to pay the required premium or because you committed fraud.
Al that being said, if you're in relatively good health you may find health insurance for less.
Go online to eHealthInsurance.com. Put in your zip code, date of birth and gender (that's all) and you should see dozens of plans available from name-brand insurance companies designed specifically for people under the age of 65.
If you find something that might work for you, pick up the phone and call one of their agents. Chat, and see what they can do for you. You should know that if you have a pre-existing condition, the HIPPA plan (though expensive) may be your only option. see more
Question
Should I switch my Dad with dementia from a MedAdvantage plan to a Medigap plan + Part D?
Hi Paula, The major concern I have for you is that if your father has not been on a Medicare Supplement (MedSup or MediGap) plan in the... Hi Paula,
The major concern I have for you is that if your father has not been on a Medicare Supplement (MedSup or MediGap) plan in the last 12 months, he may not qualify.
A few states have "open enrollment" for MedSup, but when I checked Oregon's web site for you it appeared that they do not: http://www.oregon.gov/DCBS/SHIBA/docs/2012_guide.pdf?ga=t
There is a table on page 7 you can look at.
Medicare's Annual Enrollment Period only applies to Medicare Advantage and Medicare Part D drug plans.
In most states, MedSup plans are only "Guaranteed Issue" (no medical underwriting, can't be declined) during a person's initial enrollment period in Medicare.
Now, if he went from Med Sup to Medicare Advantage last year, he should be entitled to something called a Medicare Advantage "trial right" where-in he can try it for a year and if he doesn't like it he can go back to his old MedSup plan.
It's also worth noting that if your father has dementia he may qualify for a Medicare Advantage Special Needs Plan (also called a SNP). I'd highly encourage you to seek help from a licensed agent.
You can go to our web site (PlanPrescriber.com) and call the number there to reach a licensed agent, or you can call 1-800-MEDICARE or go to your local social security office.
Your Medicare Advantage plan should have an accessible network of doctors, but if the plan your father is on does not, talk to someone and look at other plans available in your area. There may be another insurer that has a better network where you live. see more
The major concern I have for you is that if your father has not been on a Medicare Supplement (MedSup or MediGap) plan in the last 12 months, he may not qualify.
A few states have "open enrollment" for MedSup, but when I checked Oregon's web site for you it appeared that they do not: http://www.oregon.gov/DCBS/SHIBA/docs/2012_guide.pdf?ga=t
There is a table on page 7 you can look at.
Medicare's Annual Enrollment Period only applies to Medicare Advantage and Medicare Part D drug plans.
In most states, MedSup plans are only "Guaranteed Issue" (no medical underwriting, can't be declined) during a person's initial enrollment period in Medicare.
Now, if he went from Med Sup to Medicare Advantage last year, he should be entitled to something called a Medicare Advantage "trial right" where-in he can try it for a year and if he doesn't like it he can go back to his old MedSup plan.
It's also worth noting that if your father has dementia he may qualify for a Medicare Advantage Special Needs Plan (also called a SNP). I'd highly encourage you to seek help from a licensed agent.
You can go to our web site (PlanPrescriber.com) and call the number there to reach a licensed agent, or you can call 1-800-MEDICARE or go to your local social security office.
Your Medicare Advantage plan should have an accessible network of doctors, but if the plan your father is on does not, talk to someone and look at other plans available in your area. There may be another insurer that has a better network where you live. see more
Question
My mother needs Medicare Part D. Does anyone have experience with this?
Hi cjnewland, I'm sorry I'm just seeing this now, but I hope you are aware that the annual enrollment period (AEP) for Medicare is... Hi cjnewland,
I'm sorry I'm just seeing this now, but I hope you are aware that the annual enrollment period (AEP) for Medicare is well underway for the 2012 plan year and ends three weeks early on December 7th.
The AEP allows you to review your mother's coverage and make sure she's still in the plan that best first her needs.
This is incredibly important to do this, and every year. Here's why.
- An analysis done by Avalere Health found that, while average premiums across all Medicare prescription drug plans (PDPs) are decreasing by approximately 4 percent next year, six of the top 10 plans are actually having premium increases.
- Increases among the top 10 plans range from a high of 14 percent to a decrease of 11 percent. And, the premiums are not the only thing you have to consider when picking a plan.
- It's also critically important that you make sure all of your mother's drugs are covered by her plan. A survey we ran from last year's AEP found that 34 percent of our customers had at least one drug that would not have been covered by their existing plan heading into 2011.
- PDP plans are only required to cover two drugs in each category and class, which means some drugs are not covered on each plan.
If your mom's prescribed medication isn't covered by her PDP, she would pay 100% of the cost for that drug out of her own pocket. And, the money she spends on that drug would not count toward helping her reach the Medicare donut hole, or the catastrophic coverage limit.
For that reason, we encourage people to double-check their drug coverage once a year during the AEP. Medicare.gov and PlanPrescriber.com both have tools that allow you to do this fairly quickly. see more
I'm sorry I'm just seeing this now, but I hope you are aware that the annual enrollment period (AEP) for Medicare is well underway for the 2012 plan year and ends three weeks early on December 7th.
The AEP allows you to review your mother's coverage and make sure she's still in the plan that best first her needs.
This is incredibly important to do this, and every year. Here's why.
- An analysis done by Avalere Health found that, while average premiums across all Medicare prescription drug plans (PDPs) are decreasing by approximately 4 percent next year, six of the top 10 plans are actually having premium increases.
- Increases among the top 10 plans range from a high of 14 percent to a decrease of 11 percent. And, the premiums are not the only thing you have to consider when picking a plan.
- It's also critically important that you make sure all of your mother's drugs are covered by her plan. A survey we ran from last year's AEP found that 34 percent of our customers had at least one drug that would not have been covered by their existing plan heading into 2011.
- PDP plans are only required to cover two drugs in each category and class, which means some drugs are not covered on each plan.
If your mom's prescribed medication isn't covered by her PDP, she would pay 100% of the cost for that drug out of her own pocket. And, the money she spends on that drug would not count toward helping her reach the Medicare donut hole, or the catastrophic coverage limit.
For that reason, we encourage people to double-check their drug coverage once a year during the AEP. Medicare.gov and PlanPrescriber.com both have tools that allow you to do this fairly quickly. see more
Question
Suppose you don't want to change a thing on your Medicare Enrollment Plan? Do you still have to fill out somet...
The plans change every year. So, you don’t have to change anything sign anything or review anything. But, it doesn’t cost you anything to... The plans change every year. So, you don’t have to change anything sign anything or review anything. But, it doesn’t cost you anything to look and make sure that you’re plan is still the right plan for your particular needs.
Let me give you two reasons why. We surveyed over 24,000 sessions on our web site from last year’s annual enrollment period (AEP). What we found was that in 1/3 of those sessions the person would not have had coverage for at least one of their prescription drugs heading into 2011 if they hadn’t reviewed and updated their drug coverage. And, we also found that 93% of the users were not in the drug plan with the lowest prescription drug costs. On average a person could have saved over $500 on their Medicare prescription drug costs by reviewing and updating their coverage.
For all of those reasons, most Medicare experts agree that it’s a good idea for people to take 10-15 minutes to quickly be sure their coverage still meets their needs. see more
Let me give you two reasons why. We surveyed over 24,000 sessions on our web site from last year’s annual enrollment period (AEP). What we found was that in 1/3 of those sessions the person would not have had coverage for at least one of their prescription drugs heading into 2011 if they hadn’t reviewed and updated their drug coverage. And, we also found that 93% of the users were not in the drug plan with the lowest prescription drug costs. On average a person could have saved over $500 on their Medicare prescription drug costs by reviewing and updating their coverage.
For all of those reasons, most Medicare experts agree that it’s a good idea for people to take 10-15 minutes to quickly be sure their coverage still meets their needs. see more
Question
Does the Medicare Advantage Plans (Part C) cover Alzheimer's medications?
The short answer is yes. The Medicare Modernization Act requires every Medicare Part D prescription drug plan to cover at least two drugs... The short answer is yes. The Medicare Modernization Act requires every Medicare Part D prescription drug plan to cover at least two drugs in each category and class. Most Medicare Advantage plans include a Part D benefit.
A quick search on PlanPrescriber.com for four popular Alzheimer's drugs showed me three plans that would cover Namenda and the generic alternatives to Razadyne (GALANTAMINE), Exelon (rivastigmine) and Aricept (donepezil) in the 94549 zip code.
You can research Part C plans online at our site or at Medicare.gov. In either case, pay attention to the plan's pharmacy network. Sometimes the price listed on a web site referances the price you'll pay at the plan's preferred pharmacy network. If you don't purchase the drugs through that pharmacy, the costs may change. see more
A quick search on PlanPrescriber.com for four popular Alzheimer's drugs showed me three plans that would cover Namenda and the generic alternatives to Razadyne (GALANTAMINE), Exelon (rivastigmine) and Aricept (donepezil) in the 94549 zip code.
You can research Part C plans online at our site or at Medicare.gov. In either case, pay attention to the plan's pharmacy network. Sometimes the price listed on a web site referances the price you'll pay at the plan's preferred pharmacy network. If you don't purchase the drugs through that pharmacy, the costs may change. see more
Question
Can a person receive Medicare benefits if they owe Social Security for over payment?
I would strongly encourage her to contact Medicare directly at 1-800-MEDICARE (1800-633-4227). TTY users should call 1-877-486-2048, 24... I would strongly encourage her to contact Medicare directly at 1-800-MEDICARE (1800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week.
She can also call the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778.
Or she can contact her local Medicaid Office.
Without more information about her particular situation, it's difficult to answer a question like this in a forum like this one. But, the people at Medicare are very knowledgable and they're there to help. Alternately, she's welcome to reach out to one of our customer care centers at 800-404-6968 - TTY User: 711. see more
She can also call the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778.
Or she can contact her local Medicaid Office.
Without more information about her particular situation, it's difficult to answer a question like this in a forum like this one. But, the people at Medicare are very knowledgable and they're there to help. Alternately, she's welcome to reach out to one of our customer care centers at 800-404-6968 - TTY User: 711. see more
Question
I am considering switching to an Medicare Advantage Plan. Where can I find information on which companies pay...
Hello. Our web site - PlanPrescriber.com - provides this side-by-side comparison service as well. But, whichever site you use, I would... Hello. Our web site - PlanPrescriber.com - provides this side-by-side comparison service as well. But, whichever site you use, I would strongly encourage you to also look at a Medicare Advantage plan's "Star Ratings."
This is a new rating system created by the Affordable Care Act that provides you with a very good quality indicator for Advantage plans.
I'm copy/pasting information here from our web site that explans the Star Ratings for MA plans:
The Overall Plan Rating provides a single summary score that makes it easy for you to compare plans based on quality and performance.
The Overall Plan Rating combines scores for the types of services each plan offers. For plans covering health services, the overall score for quality of those services covers 36 different topics in 5 categories:
1. Staying healthy: screenings, tests, and vaccines: Includes how often members got various screening tests, vaccines, and other check-ups that help them stay healthy.
2. Managing chronic (long-term) conditions: Includes how often members with different conditions got certain tests and treatments that help them manage their condition.
3. Ratings of health plan responsiveness and care: Includes ratings of member satisfaction with the plan.
4. Health plan member complaints and appeal: Includes how often members filed a complaint against the plan.
5. Health plan telephone customer service: Includes how well the plan handles calls from members.
For plans covering drug services, the overall score for quality of those services covers 17 different topics in 4 categories:
•Drug plan customer service: Includes how well the drug plan handles calls and makes decisions about member appeals.
•Drug plan member complaints and Medicare audit findings: Includes how often members filed a complaint about the drug plan and findings from Medicare's audit of the plan.
•Member experience with drug plan: Includes member satisfaction information.
•Drug pricing and patient safety: Includes how well the drug plan prices prescriptions and provides updated information on the Medicare website. Includes information on how often members with certain medical conditions get prescription drugs that are considered safer and clinically recommended for their condition.
For plans covering both health & drug services, the overall score for quality of those services covers all of the 53 topics listed above.
For quality of health services, the scoring information comes from sources that include:
•Member surveys done by Medicare
•Information from clinicians
•Information submitted by the plans
•Results from Medicare's regular monitoring activities
For quality of drug services, the scoring information comes from sources that include:
•Results from Medicare's regular monitoring activities
•Reviews of billing and other information that plans submit to Medicare
•Member surveys done by Medicare
I hope this is helpful. see more
This is a new rating system created by the Affordable Care Act that provides you with a very good quality indicator for Advantage plans.
I'm copy/pasting information here from our web site that explans the Star Ratings for MA plans:
The Overall Plan Rating provides a single summary score that makes it easy for you to compare plans based on quality and performance.
The Overall Plan Rating combines scores for the types of services each plan offers. For plans covering health services, the overall score for quality of those services covers 36 different topics in 5 categories:
1. Staying healthy: screenings, tests, and vaccines: Includes how often members got various screening tests, vaccines, and other check-ups that help them stay healthy.
2. Managing chronic (long-term) conditions: Includes how often members with different conditions got certain tests and treatments that help them manage their condition.
3. Ratings of health plan responsiveness and care: Includes ratings of member satisfaction with the plan.
4. Health plan member complaints and appeal: Includes how often members filed a complaint against the plan.
5. Health plan telephone customer service: Includes how well the plan handles calls from members.
For plans covering drug services, the overall score for quality of those services covers 17 different topics in 4 categories:
•Drug plan customer service: Includes how well the drug plan handles calls and makes decisions about member appeals.
•Drug plan member complaints and Medicare audit findings: Includes how often members filed a complaint about the drug plan and findings from Medicare's audit of the plan.
•Member experience with drug plan: Includes member satisfaction information.
•Drug pricing and patient safety: Includes how well the drug plan prices prescriptions and provides updated information on the Medicare website. Includes information on how often members with certain medical conditions get prescription drugs that are considered safer and clinically recommended for their condition.
For plans covering both health & drug services, the overall score for quality of those services covers all of the 53 topics listed above.
For quality of health services, the scoring information comes from sources that include:
•Member surveys done by Medicare
•Information from clinicians
•Information submitted by the plans
•Results from Medicare's regular monitoring activities
For quality of drug services, the scoring information comes from sources that include:
•Results from Medicare's regular monitoring activities
•Reviews of billing and other information that plans submit to Medicare
•Member surveys done by Medicare
I hope this is helpful. see more
Question
As my mother's POA, do I still need that other document to speak to Medicare on my Mother's behalf?
@mrtvz64 - This is a great question that we get all the time in our call center. Thanks for asking. The short answer is that you need to... @mrtvz64 - This is a great question that we get all the time in our call center. Thanks for asking. The short answer is that you need to have a Medical POA.
The Medical or health care power of attorney (POA) is a legal document that designates you — referred to as your mother's health care agent or proxy — to make medical decisions for her if she can't do that for herself.
These Medical POAs are different from a power of attorney that authorizes you to make financial transactions for your mom.
I hope that helps!
Ross see more
The Medical or health care power of attorney (POA) is a legal document that designates you — referred to as your mother's health care agent or proxy — to make medical decisions for her if she can't do that for herself.
These Medical POAs are different from a power of attorney that authorizes you to make financial transactions for your mom.
I hope that helps!
Ross see more
Question
Are we at risk of losing Medicare if my dad was released from rehab and we do not provide him with the full-ti...
It’s difficult to answer your question without some additional pieces of information, like which state you live in and which type of... It’s difficult to answer your question without some additional pieces of information, like which state you live in and which type of Medicare coverage you have; basic Medicare, Medicare Advantage or a Medicare Supplement.
But, here are some general rules that apply to your situation:
1. Your father’s eligibility for basic Medicare coverage – also called “original Medicare” – is primarily based on his citizenship and the length of time that he paid Medicare related payroll taxes. If he worked for at least 10 years and paid payroll taxes that hole time, he should get Medicare Part A for free and Medicare Part B for $115 per month. That $115 premium is usually deducted from a person’s monthly social security check. There are always exceptions with Medicare, but these rules and prices apply for most people.
2. I’m not aware of anyone’s Medicare coverage being cancelled for any reason, except in instances of fraud. Although, again, there are always exceptions with Medicare.
If I’m reading between the lines of your question correctly, I’d assume you’re more concerned about whether or not your Medicare coverage will cover the cost of a professional caregiver, if they’re not the caregiver prescribed by your father’s treatment center. And, again, this will likely depend on what type of coverage you have, what state you live in and whether or not the caregiver services you wish to select are covered by The Center for Medicare and Medicaid Services, or by your father’s ancillary Medicare insurance, if he has any.
If you have supplemental insurance – Medicare Advantage or a Medicare Supplement - the best advice I can give you is to contact the insurance company directly and explain the situation. They should be able to tell you if your desired caregiver would qualify. But, the issue should not affect basic Medicare eligibility. Worst case scenario, you still have Medicare but pay for the caregiver out of your own pocket.
For more information on your specific problem, I would encourage you to speak to Medicare at 1-800-MEDICARE. see more
But, here are some general rules that apply to your situation:
1. Your father’s eligibility for basic Medicare coverage – also called “original Medicare” – is primarily based on his citizenship and the length of time that he paid Medicare related payroll taxes. If he worked for at least 10 years and paid payroll taxes that hole time, he should get Medicare Part A for free and Medicare Part B for $115 per month. That $115 premium is usually deducted from a person’s monthly social security check. There are always exceptions with Medicare, but these rules and prices apply for most people.
2. I’m not aware of anyone’s Medicare coverage being cancelled for any reason, except in instances of fraud. Although, again, there are always exceptions with Medicare.
If I’m reading between the lines of your question correctly, I’d assume you’re more concerned about whether or not your Medicare coverage will cover the cost of a professional caregiver, if they’re not the caregiver prescribed by your father’s treatment center. And, again, this will likely depend on what type of coverage you have, what state you live in and whether or not the caregiver services you wish to select are covered by The Center for Medicare and Medicaid Services, or by your father’s ancillary Medicare insurance, if he has any.
If you have supplemental insurance – Medicare Advantage or a Medicare Supplement - the best advice I can give you is to contact the insurance company directly and explain the situation. They should be able to tell you if your desired caregiver would qualify. But, the issue should not affect basic Medicare eligibility. Worst case scenario, you still have Medicare but pay for the caregiver out of your own pocket.
For more information on your specific problem, I would encourage you to speak to Medicare at 1-800-MEDICARE. see more
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