Posts Tagged ‘Medicare’

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Turning 65 years old and enrolling in Medicare seem to be a pleasant change. Getting rid of the expensive health insurance is a welcome transformation, until one is faced with all the choices they have to make.

Medicare has parts which are A, B, C, and D.

Part A covers hospitalization, qualified nursing home rehabilitations, and mental health hospitalizations. Part B covers outpatient hospital services,  doctor visits, diagnostic services, such as blood tests, x-ray, MRIs, CT Scans, injectable drugs, durable medical equipment, etc. Part D is a drug plan for pharmacy based prescriptions. Medicare part C is an exchange of all of the above to convert Medicare into a “private insurance”.

Medicare does not pay for medical care in full; therefore there is a need for a supplemental plan. So, to further confuse matters those supplemental plans comes lettered as well. Presently those letters run from A to N. Some counties are skipping some letters in between.

Moreover, through the Medicare program there are about 40 prescription plans available in each state. Prices, coverage, administrative rules, deductibles, co-pays, and cost shares vary between these plans. Medicare made every effort to streamline and explain all these details, but unfortunately there are so many rules and details, that most people get lost in the information overload.

We are at MedBillsAssist explain all parts of Medicare and help you chose the best possible solution for your specific needs.

Below are some highlights in phase two of the Health Care Reform Bill.

This is the year when our tax codes are going through significant changes driven by the health care law.  Overall, health care is getting more regulated, therefore it is forcing businesses, health care providers and insurance companies to spend more money on administration.  There are a lot of plans that are studying and “advising” on how to make health care better.  Sadly, those groups and advisory bodies should have been created prior to the enactment of this law.

• Minimum Medical Loss Ratio

Health plans, including grandfathered plans, must report on the share of premium dollars spent on medical care and provide consumer rebates for excessive medical loss ratios.

• Consumer Protection

Prohibits individual and group health plans from placing lifetime limits on the dollar value of coverage as well as rescinding coverage except in cases of fraud.  Annual limits are still in effect until 2014.  The provision also prohibits plans from denying children coverage based on pre-existing medical conditions.

• Standardizing the Definition of Qualified Medical Expense

Match the definition of qualified medical expenses for HSAs, FSAs and HRAs to the definition used by the IRS itemized deduction.  Over-the-counter medicine will now only be considered as medical expense of accompanied by a doctor’s prescription.

• Reporting Health Coverage Costs on Form W-2

Requires employers to disclose the value of the benefit provided by the employer for each employee’s health insurance coverage on the employee’s annual Form W-2.

• Creating Simple Cafeteria Plans

Creates a Simple Cafeteria Plan to provide a vehicle through which small businesses can provide tax‐free benefits to their employees.

• Appealing Health Plan Decisions

Appoints the right to appeal medical claim and/or policy decisions made by any health plan and the right to appeal decisions made by the health plan to an outside, independent decision-maker, no matter what state a person lives in or what type of health coverage a person may have. This includes, for the first time, new self-funded plans.

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Centers for Medicare and Medicaid Services (CMS) erroneously notified 400 thousand Medicare Advantage (MA) beneficiaries that some MA plans will no longer be offered next year in service areas where plans will continue to operate. CMS blamed the affected plans, contending that they hadn’t properly filled out forms.
According to CMS spokesman the issue is limited in scope in terms of number of organizations affected and beneficiaries impacted. Don’t you feel better already? It only affected 400 thousand seniors and a limited number of insurance companies.
A little known fact in this matter is that MA plans aren’t allowed to send out communications without CMS approval. Therefore they are not allowed to correct CMS erroneous letter, unless it is approved by CMS.
Kindly, CMS agreed to review any written notice insurance companies (MA Plans) would like to send to their members.
One must ponder about this. Was this a simple problem of incomplete paperwork? Was this an attempt to get beneficiaries back to traditional Medicare? Was this an elaborate attempt to question MA plans reputation? We will never know…