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Medicare News

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July 19, 2021

Medicare is a health insurance program for persons over the age of 65 in the United States. People under the age of 65, such as those with disabilities or those who have permanent kidney failure, may be eligible for Medicare. In this blog, we shall learn about Medicare benefits for seniors.

Medicare assists with healthcare costs, although it does not cover all medical bills or most long-term care costs. You can receive Medicare coverage in a variety of ways. You can purchase a Medicare Supplement Insurance (Medigap) policy from a private insurance provider if you opt to have Original Medicare (Part A and Part B) coverage.

Coverage

Part A of Medicare covers hospitalization. It pays a portion of the costs of inpatient hospital stays, hospice care, some home health care, and skilled nursing facility care.

Medical insurance is covered through Medicare Part B. Part B covers doctor visits, medical supplies, mental health services, preventive care, and a limited amount of prescription medicines.

Part D of Medicare covers a greater range of prescription drugs.

What is Medicare Advantage

Medicare Part C is another name for Medicare Advantage. Private medical insurance companies that have a contract with Medicare to offer coverage administer these plans. Parts A and B are merged into a single policy.

All Medicare-approved services must be covered by Medicare Advantage, and some carriers may offer additional benefits such as vision, hearing, and dental care.

Prescription drug coverage

Prescription drug coverage is provided under Medicare Part D.

Part D plans are sold separately by private medical insurance firms.

Prescription drug coverage is available through Medicare Advantage plans. However, a person cannot get a separate policy on top of that.

Part D of Medicare is an optional benefit. A late enrollment penalty may apply if a person does not enroll when they are first eligible.

Individuals can use Medicare’s online Find a Medicare Plan page to locate a prescription drug plan in their area.

Supplementary insurance plans (Medigap)

Supplementary insurance or Medigap plans are Medicare policies that help pay for some out-of-pocket expenses.

Out-of-pocket expenses that may be covered include:

  • Deductibles
  • coinsurance
  • copayments

Furthermore, some Medigap plans cover medical treatment needed while traveling outside of the US.

Some Medigap policies have exclusions. The following are typically excluded from coverage:

  • dental treatment
  • long-term care
  • hearing aids
  • eyeglasses
  • private nursing
  • vision care

Finding the Right Medicare

A Medicare plan that covers all of your medical and financial needs is the best option to go for. Each Medicare plan has advantages and cons, ranging from cost-effectiveness to provider limitations and more.

If you’re thinking of enrolling in a Medicare plan this year, you might be wondering which one is the best since different plans have different Medicare benefits for seniors.

While there are many Medicare plan alternatives available, the optimal plan for you will be determined by your medical and financial circumstances. Fortunately, you may compare the benefits and drawbacks of each Medicare plan to pick one that is right for you.

Whether you go for original Medicare with add-ons or Medicare Advantage, make sure that you around and compare different plans. National Senior Services can help you find the best Medicare for you.

chris dsouaz

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June 15, 2021

Medicare is a federal health insurance program that subsidizes healthcare services in the United States. The plan covers those aged 65 and over, as well as younger persons who meet certain conditions and people with particular conditions. Medicare is broken down into numerous plans that cover a wide range of healthcare needs, some of which are paid for by the covered person. While this allows the program to provide consumers with more cost and coverage options, it also adds to the program’s complexity for those looking to enroll. In this blog, you will get to know about Medicare benefits policy manual.

How Medicare Works

Medicare is a federally sponsored national healthcare program in the United States. In 1965, Congress established the program as part of the Social Security Act to provide health insurance to persons aged 65 and up who did not have it.

The Centers for Medicare and Medicaid Services (CMS) currently administers the program, which now covers persons with certain disabilities, as well as individuals with end-stage renal illness and amyotrophic lateral sclerosis (ALS), sometimes known as Lou Gehrig’s illness. Medicare is divided into 4 components, each of which provides distinct types of services to the insured:

  • Medicare Part A
  • Medicare Part B
  • Medicare Part C
  • Medicare Part D

Types of Medicare Coverage

Individuals can choose from 4 distinct types of Medicare programs, as indicated above. Basic Medicare coverage is primarily provided by Parts A and B (commonly known as Original Medicare) or the Medicare Part C plan. Individuals can also sign up for a Medicare Part D plan.

Medicare Part A

Hospitals and similar inpatient or inpatient-like settings, such as skilled nursing facilities, hospice, and some home-based healthcare, are covered under Medicare Part A. However, this plan excludes long-term or custodial care. Anyone who receives Social Security income is automatically covered. Enrollment is available on the Social Security website for those who do not currently receive benefits.

Medicare Part B

Outpatient treatment, such as doctor visits, is often covered by Medicare Part B. Preventive services, ambulance services, some medical equipment, and mental health care are all included under Part B. This plan also covers some prescription medicines. This plan’s typical monthly premium for 2021 is $148.50, with a deductible of $203. Anyone with an annual salary of more than $88,000 ($176,000 for married couples) pays a higher premium.

Medicare Part C

These Medicare Advantage plans, often known as Medicare Supplements, must provide coverage that is as least as good as Original Medicare (Plans A and B). Instead of purchasing Medicare Advantage plans directly from the government, consumers purchase them from private insurers. Many insurance plans have yearly out-of-pocket spending caps.

Many also include copays, coinsurance, deductibles, and even payments linked to insurance while traveling outside of the United States, which original Medicare patients would otherwise have to obtain through supplemental insurance such as a Medigap plan. Dental, eye, and hearing care may be included in some policies.

Medicare Part D

Through Medicare Part D, you can get extra prescription medication coverage. Part D is available to Medicare Part A and Part B beneficiaries who want to get help paying for prescription drugs that their original Medicare plans don’t cover.

chris dsouaz

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June 10, 2021

Currently, more than 18 million Americans are enrolled in Medicare Advantage plans, with roughly one-third of all Medicare beneficiaries opting for one. Americans are not only enrolling in these affordable Medicare solutions in greater numbers, but they are also satisfied with them.

So, what’s the catch? Medicare Advantage has created a plan that provides subscribers with affordable, high-quality, patient-centered care with a wide range of options while also motivating providers to keep people healthy.

While the affordable Medicare solution is not without flaws, it has proven to be a success that the healthcare profession can learn from. From the pages of Medicare Advantage’s playbook, we can learn a few things.

Keep care affordable with accurate compensation for insurers

For starters, Medicare Advantage has devised an incentive scheme that rewards insurers equitably for providing value-based care. However, this wasn’t always the case. In the beginning, Medicare Advantage insurers were paid the same amount for everyone registered in their health plan, regardless of whether they were affordable or had complicated chronic diseases.

As a result, the government seemed to compensate healthy enrollees while underpaying sicker ones. As a result, insurers were compelled to enroll healthy patients while avoiding sicker ones, creating a barrier to providing high-quality, affordable Medicare solutions to those who needed them.

The Centers for Medicare & Medicaid Services (CMS) adopted risk adjustment for Medicare Advantage plans in 2004 to address this issue. Risk adjustment, in general, describes a single individual’s health and well-being, aggregates the health of all individuals throughout a plan, and then determines how much a single insurance company or healthcare provider will be paid per patient.

These payments are determined by how sick or healthy a member is, ensuring that sick patients receive the affordable Medicare solutions they require and that physicians get compensated for providing that care. Because Medicare Advantage plans are reimbursed for the average cost of caring for an individual, it incentivizes organizations to provide cost-effective care to a population.

With such results, it’s simple to understand why Medicare Advantage’s use of risk adjustment is a valuable lesson for the government as it seeks to bend the expense curve of Medicare and healthcare in general while preserving access and quality.

Incentivize comprehensive care coordination for better care outcomes

An affordable Medicare plan’s success isn’t determined solely by its ability to control costs; it must also produce high-quality outcomes. Chronic disease management and care coordination are directly impacted and improved by Medicare Advantage.

Provider networks operating under Medicare Advantage models, on the other hand, have a global budget related to their capacity to track and report on care coordination, clinical results, and beneficiary satisfaction.

This encourages practitioners to accurately document clinical diagnoses in order to guarantee that beneficiaries receive the care management and related services that are suitable for their condition. Effective recording and diagnosis have been shown to lead to earlier treatment interventions, higher treatment rates, affordable Medicare solutions, and improved health outcomes.

A path forward

Certainly, Medicare Advantage has its share of difficult difficulties. However, it is apparent that it is a successful aspect of the healthcare system that has provided improved value for each healthcare dollar spent for both enrollees and the government.

Take a look at Medicare Advantage and its value-based approach to managing it as government officials and the industry navigate the healthcare changes and learn from what works.

Meanwhile, if you’re looking for affordable Medicare solutions for senior health, choose National Senior Services. We are here to help you locate the correct coverage by guiding you through the process step by step. With so many alternatives and variables to consider, we can assist you to understand which plan or plans will work best for you

chris dsouaz

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February 1, 2017

Although popular love songs might tell you otherwise, a broken heart can’t kill you—but heart disease can. Heart disease is the leading cause of death in the United States for both men and women, taking about 610,000 lives each year—that’s 1 in every 4 deaths.

You might not be able to avoid Cupid’s arrow, but you can take steps to lower your risks and help prevent heart disease. Start by scheduling an appointment with your doctor to discuss whether you’re at risk for heart disease.

Medicare covers a cardiovascular disease screening at no cost to you every 5 years. The screening includes tests to help detect heart disease early and measures cholesterol, blood fat (lipids), and triglyceride levels.

If you and your doctor discover that you’re at risk for a heart attack or stroke, there are steps you can take to help prevent these conditions. You might be able to make lifestyle changes (like changing your diet and increasing your activity level or exercising more often) to lower your cholesterol and stay healthy.

February is American Heart month, so start showing your heart love by visiting the Million Hearts® Healthy Eating & Lifestyle Resource Center. Million Hearts is a national initiative to prevent 1 million heart attacks and strokes by the end of this year. The resource center was developed in partnership with EatingWell magazine, and features lower sodium, heart-healthy recipes and family-friendly meal plans to help manage sodium intake, a major contributor to high blood pressure and heart disease. All the recipes include nutritional facts and average cost per serving information. Use the search and filter options to quickly find the right meal for yourself and your family.

While you’re celebrating family and friends this Valentine’s Day, don’t forget to show your heart some love, too.

Filed under: Medicare coverage, Uncategorized

R Fisher

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January 18, 2017

If you’re among the 7 million Americans enrolled in the Qualified Medicare Beneficiary (QMB) Program, providers aren’t allowed to bill you for medical services and items that Medicare covers. This means you can’t be billed for Medicare deductibles, coinsurance, and copayments.

Here are 3 tips if you get a bill for these charges:

  1. Tell the provider or debt collector that you have QMB and can’t be charged for Medicare deductibles, coinsurance, and copayments. Show your provider your Medicaid or QMB card every time you get medical services or items. If you already made payments on a bill for services and items Medicare covers, you have the right to a refund.
  2. If the medical provider won’t stop billing you, call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048. The agent can confirm that you have QMB. Medicare can also ask the provider to stop improper billing, and refund any incorrect payments you made.
  3. If you have a problem with debt collection, you can send a complaint to the Consumer Financial Protection Bureau (CFPB) online or call the CFPB toll-free at (855) 411-2372. TTY users can call (855) 729-2372. CFPB will forward your complaint to the company and work to get you a response from them. Find out about your rights when responding to a debt collector or learn how to dispute an error on your credit report.

Remember, being in QMB means that you don’t pay Medicare deductibles, coinsurance, and copayments. If a provider asks you to pay, that’s illegal. We’re here to help.

Filed under: Uncategorized

R Fisher

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National Senior Services is not connected with or endorsed by the US government or the federal Medicare program; Medicare has neither reviewed nor endorsed this information. We are a licensed and approved Medicare Service Provider.

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RT : The links between heart disease and stress are clear so have a good laugh today.

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