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Welcome to Medicare & You 2017. Since the health care law was passed more than 6 years ago, we’ve seen a transformation in this nation’s health care. We’ve covered 20 million more Americans, while providing higher-quality care at reduced costs. And now, the Quality Payment Program, the result of a bipartisan bill passed last year, builds on these improvements. This program helps make sure Medicare doctors are rewarded for providing improved care to you, instead of being paid based on the number of services they...
Medicare recipients who want to enroll or change their Medicare health care and Part-D coverage for 2014 will be able to this week from Oct. 15 to Dec. 7. Beginning the 15th seniors can now change any type of Medicare coverage you choose but changes don’t take effect Jan. 1. But now is the best time to review your needs. Reviewing your options earlier rather than later will provide you a better position if you need to make changes. If you are already enrolled your plan will provide you information about plan changes each fall for the new year. You should review your needs and compare next year’s plan for a possible change in your monthly deductibles, premiums and co-payments. Medicare Supplement providers can also change your prescription drugs coverage by changing tiers or dropped medications from the list of drugs ( formulary). Seniors should check that your plan will continue to offer equivalent medication coverage on your medications and will continue to work with your pharmacy. If you are displeased with your plan or upcoming changes, you can make changes to your coverage during this open enrollment. If you are pleased with your current Medicare plan, consider looking at other or new Medicare choices in your area that may exceed your individual needs for the new year. Questions to Ask. Have you changed the medications you take? Are your medications still covered on your current plan in 2014? Have you been diagnosed with a new medical diseases or conditions? Has your health care provider situation has changed? Are your plan premiums, co-pays or deductibles increasing? Have you moved...
Health insurance in the United States is predominantly privatized, with almost 60% of Americans getting their insurance through a private health insurance company. The remaining Americans are either going uninsured or using public health insurance programs. Not everyone who can’t afford sufficient private health insurance will qualify for public health insurance; in fact, most won’t. This means that the majority of Americans are under-insured or not insured at all. Below is a more in-depth look into how both the private and public health insurance systems work. Private Health Insurance Health insurance in the United States is, for the most part, owned and operated by private companies. While there are many types of private health insurance plans, they can all be grouped into 3 larger categories: Fee-For-Service (Traditional Private Health Insurance); Health Maintenance Organizations (HMOs); Preferred Provider Organizations (PPOs). Fee-For-Service is private health insurance that requires you to pay monthly premiums to your insurance company, which will cover most of your health costs. You will then be required to pay extra for certain services. Health Maintenance Organizations (HMOs) are prepaid health plans. You pay monthly premiums, but unlike fee-for-service you must receive your health care directly from their facilities. You can get an HMO Insurance Quote here. Preferred Provider Organizations (PPOs) are health insurance where you pay a monthly premium, along with a small co payment when you visit the doctor. This type of plan limits the doctors and medical facilities you can use. Public Health Insurance Publicly funded health insurance is available to senior citizens and low-income individuals and families, if they meet certain requirements. The primary vehicles for...
Most Americans have private health insurance. This is a big monthly expense and one that many would prefer to do without. But what are the advantages and disadvantages of a country using this type of health care system? Read below to find out. Advantages: 1. You Choose Your Doctor In the private healthcare system you often have more flexibility in choosing a doctor as well as medical facility. For patients that want the same doctor all the time, this can be a very important advantage of this type of system. 2. Shorter Wait Times If you are having a surgery that is necessary but not life threatening, there are often long wait times. In a private health insurance system the patient will often have shorter wait times because the medical facility is less busy. And even if there are a lot of people waiting, you can often by pass the line by paying a little bit extra for faster medical attention. 3. Improved Facilities Unfortunately, because the public system is funded with government money it does not have access to as much funds as the private sector one do. This means that public hospitals and health care facilities are often overcrowded, and lacking certain comfort amenities. Private health care facilities, on the other hand, are usually well maintained, with private wards, private bathrooms, phones, TVs, and better tasting food. Disadvantages: 1. Private Health Insurance Costs More than Public Health Insurance While the US government might be saving a marginal amount of money by having a private healthcare system instead of a public one; there is no doubt that American...
Poverty alone cannot ensure you that you are eligible for receiving Medicaid benefits. About 60% of poor Americans are not covered by Medicaid just because they do not qualify the criteria for eligibility to get Medicaid services. Therefore, it is essential to know what the different aspects of Medicaid eligibility are and who can apply for Medicaid benefits. Medicaid is a federal and state government joint venture to provide medical insurance coverage to the people belonging to the low income and resources group. Even though Medicaid is a federal and state government funded initiative, the rule regarding eligibility and the range of coverage differ considerably for each state. However, some common criteria are applicable in all cases. The most important factor in deciding the eligibility for Medicaid is income and resources. The income threshold may be different for the various states of the country. The calculation of one’s resources also has slight variations from state to state. Usually, the factors that are considered while assessing the resources are bank accounts, real estate property like land and house, and other assets and items which will make cash if sold. The State Medical Assistance office may help you to assess your eligibility for Medicaid plan. If you receive Supplemental Security Income from the Social Security Administration, you could be eligible for Medicaid depending on your state’s rule. Other factors that affect the eligibility for Medicaid are age, residency, citizenship or legal status, pregnancy, and family size. Low-income families with children, children under 19 (in some states 21), pregnant women and the child born when the mother is on Medicaid, single parents,...
Preferred Provider Organizations (PPO’s) are Managed Care Organization (MCO) that contract with a network of doctors, hospitals, and other health care providers. This agreement allows treatment at a reduced cost. In other words, Preferred Provider Organizations offer discounts to visit health care providers, within their provider’s network. Two most important characteristics of PPOs are: The first important characteristic of PPO is that it allows its plan members to visit any doctor or hospital without referrals from the members’ Primary Care Physicians (PCP). In other words, it is just opposite to another popular type of managed care plan, HMO (Health Maintenance Organization), which needs referrals from a PCP. Another appealing characteristic is the flexibility to visit or choose doctors and hospitals outside the network. But it also has some limitations—visits outside the network are not fully covered as visits within the network; thus require higher payments from patients. Despite of above mentioned facts, both these characteristics (no need to referrals and flexibility to choose outside the network) are very appealing to many employees. So, if you wish to avail any of these appealing characteristics, then it’s worth your time to consider PPO as a part of your health benefit package. In sum, PPO’s are virtually having all the advantages of managed care health insurance and fee-for-service health insurance. The only disadvantage is that you must have to pay full rate for physicians and hospitals outside the network. So if you agree to pay for your choice, then PPO’s are the best option for you. Points To Be Considered: Checking and evaluating the network of doctors. When evaluating a Preferred Provider...
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MedicareHelp.org is a privately-owned Non-governmental agency. The government website can be found at HealthCare.gov.
Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options. Enrollment depends on the plan’s contract renewal.
Every year, Medicare evaluates plans based on a 5-star rating system.
