According to the American Academy of Pediatrics, every child should receive high quality health care that is accessible, family-centered, culturally competent, coordinated, continuous, compassionate, and comprehensive (1). This care is best offered through a medical home, an ongoing family-centered partnership with a child health professional or team, in which all of the patient’s needs are met (1). Children who receive care in the context of a medical home are more likely to have regular preventive check-ups (which can lead to the early identification and treatment of problems) and are less likely to have emergency room visits (1). However, the latest estimates indicate that less than half of children receive care within a medical home, statewide and nationally (2). Not surprisingly, children without health insurance are less likely to access needed care than those with coverage (3). While the number of insured children has increased in recent years, some remain uninsured and many are at risk of losing coverage if investments in public insurance programs are not maintained (3).
This is only a summary of benefits describing the policies' most important features. The policy is the insurance contract. You must read the policy itself to understand all the rights and duties of both you and your insurance company. These policies may not fully cover all of your medical costs. Neither BCBSNC nor its agents are affiliated with Medicare. Plan A: BMS A, 12/17; Plan B: BMS B, 12/17; Plan C: BMS C, 12/17; Plan D: BMS D, 12/17; Plan F: BMS F, 12/17; Plan High-Ded F: BMS HDF, 12/17; Plan G: BMS G, 12/17; Plan K: BMS K, 12/17; Plan L: BMS L, 12/17; Plan M: BMS M, 12/17; Plan N: BMS N, 12/17. 
This information is not a complete description of benefits. Call 1-866-405-8762 (TTY: 711) for more information. Out-of-network/non-contracted providers are under no obligation to treat UPMC for Life members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services. Other physicians/providers are available in the UPMC for Life network.

This information is not a complete description of benefits. Call 1-866-405-8762 (TTY: 711) for more information. Out-of-network/non-contracted providers are under no obligation to treat UPMC for Life members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services. Other physicians/providers are available in the UPMC for Life network.

HealthPartners is committed to helping you be your best, every day. That’s why we work with partners to help you get the care and coverage you need. We have a partnership in Iowa and Illinois with UnityPoint Health. We also have a partnership in North Dakota and South Dakota with Sanford Health. And we have a collaboration in Wisconsin with Bellin Health, ThedaCare and others through Robin with HealthPartners.
The Patient Protection and Affordable Care Act has restructured payments to Medicare Advantage plans in an effort to reduce budget spending on Medicare, but for the last few years the payment changes have either been delayed or offset by payment increases. When the law was first passed, many people – including the CBO – projected that Medicare Advantage enrollment would drop considerably over the coming years as payment reductions forced plans to offer fewer benefits, higher out-of-pocket costs, and narrower networks.

If you wish to start comparing Medicare Advantage plans in Minnesota today, eHealth has a plan finder tool on this page that makes it easy to find plan options in your location. Simply enter your zip code to see available Medicare plan options; you can also enter your current prescription drugs to help narrow your search to Medicare plans that cover your medications.

Humana Pharmacy mail delivery shipments for new prescriptions are typically received within 7-10 days from the date of your order and in 5-7 days for a refill. If you don’t receive your shipment within these estimated times, call 1-800-379-0092 (TTY: 711). Humana Pharmacy is available Monday – Friday, 8 a.m. – 11 p.m., and Saturday, 8 a.m. – 6:30 p.m., Eastern time
Original "fee-for-service" Medicare Parts A and B have a standard benefit package that covers medically necessary care as described in the sections above that members can receive from nearly any hospital or doctor in the country (if that doctor or hospital accepts Medicare). Original Medicare beneficiaries who choose to enroll in a Part C Medicare Advantage health plan instead give up none of their rights as an Original Medicare beneficiary, receive the same standard benefits—as a minimum—as provided in Original Medicare, and get an annual out of pocket (OOP) upper spending limit not included in Original Medicare. However they must typically use only a select network of providers except in emergencies, typically restricted to the area surrounding their legal residence (which can vary from tens to over 100 miles depending on county). Most Part C plans are traditional health maintenance organizations (HMOs) that require the patient to have a primary care physician, though others are preferred provider organizations (which typically means the provider restrictions are not as confining as with an HMO), and a few are actually fee for service hybrids.
Indeed, the Democrats' commitment to government-run health care is all the more menacing to our seniors and our economy when paired with some Democrats' absolute commitment to end enforcement of our immigration laws by abolishing Immigration and Customs Enforcement. That means millions more would cross our borders illegally and take advantage of health care paid for by American taxpayers.
The Independent Payment Advisory Board (IPAB), which the Affordable Care Act or "ACA" created, will use this measure to determine whether it must recommend to Congress proposals to reduce Medicare costs. Under the ACA, Congress established maximum targets, or thresholds, for per-capita Medicare spending growth. For the five-year periods ending in 2015 through 2019, these targets are based on the average of CPI-U and CPI-M. For the five-year periods ending in 2020 and subsequent years, these targets are based on per-capita GDP growth plus one percentage point.[87] Each year, the CMS Office of the Actuary must compare those two values, and if the spending measure is larger than the economic measure, IPAB must propose cost-savings recommendations for consideration in Congress on an expedited basis. The Congressional Budget Office projects that Medicare per-capita spending growth will not exceed the economic target at any time between 2015 and 2021.[88]
The most significant change to the Medicare program, since its enactment in 1965, began on Jan. 1, 2006. Medicare now has a prescription drug benefit (Medicare Part D). In the fall of each year, all Minnesotans with Medicare receive information about the Medicare Part D program and the Annual Open Enrollment Period for Medicare Part D and Medicare Advantage plans. Agencies, organizations and people that work with Minnesotans with Medicare will want to be kept apprised of the latest Part D information and its effect on Minnesotans with Medicare.
In 2013-14, an estimated 88% of California youth ages 12-17 received a routine health check-up within the past 12 months, up from about 77% in 2001. However, about 7% of all California children—and 10% of lower-income children—had no usual source of health care in 2013-14. Estimates by race/ethnicity ranged from 5% (multiracial and white) to 11% (African American/black) with no usual source of care. Among children who did have a regular source of care, the majority (63%) used a doctor’s office or HMO, rather than hospitals, clinics, urgent care, emergency rooms, or other settings. For children living below 200% of the Federal Poverty Level, only 48% used a doctor’s office or HMO, compared to 77% for children from higher-income families.
Special Election Period: Generally, once you enroll into a Medicare Advantage plan, you stay enrolled in the plan until the next Annual Election Period (AEP) opens. However, there are some life events that might qualify you for a Special Election Period (SEP) during other times of the year, so you can make a change to your Medicare Advantage coverage. Some examples of these life events include (but aren’t limited to):
Individuals seeking to enroll in the Medi-Cal program must first visit the nearest Department of Social Services (DPSS) / County Welfare Department and apply for benefits. If eligibility is established, the beneficiary is advised to attend an on-site information session administered by Health Care Options - a California Department of Health Services private contractor - to learn about available health care choices.
There are several types of Medicare Advantage plans, such as Health Maintenance Organization (HMO) plans, Preferred Provider Organization (PPO)* plans, Private Fee-For-Service (PFFS) plans, and Special Needs Plans (SNPs). Other Medicare Part Advantage plan options include HMO Point-Of-Service (HMO POS) plans and Medical Savings Account (MSA) plans. Depending on where you live, you might not find every type of plan available to you.
ACA provided bonus payments to plans with ratings of 4 (out of 5) stars or more. The Obama administration launched an $8.35 billion demonstration project in 2012 that increased the size of the bonus payments and increased the number of plans receiving bonus payments, providing bonus payments to the majority of Medicare Advantage plans.[6] According to the Government Accountability Office (GAO) this demonstration project cost more than the previous 85 demonstration projects beginning in 1995 combined.[7]
Don't make a decision on your choice of Part D Medicare plans based on the premium and deductible alone. It's critical that you verify that your medications are covered. You find this information, and the co-payment tiers, in the formulary. On each PDP page (above) we post links to the formulary and pharmacy web pages, and the phone numbers to contact the plan.

Medicare Advantage (Part C) plans are run by private insurance companies and combine Medicare Parts A (hospital coverage) and B (doctor coverage) plus additional benefits all in one plan. Many plans also include prescription drug coverage and are known as MA-PD or Medicare Advantage with Prescription Drug plans. Medicare Advantage plans may come with no additional premium beyond what you already pay for Medicare Part B. To be eligible to enroll in a Medicare Advantage plan, you must have Original Medicare (Parts A and B) and continue to pay your Medicare Part B premium each month, unless it is otherwise paid for under Medicaid or by another party.

Health Maintenance Organization (HMO) plans: One of the most popular types of managed-care plans, this type of Medicare Advantage plan comes with a provider network that you must use to be covered by the plan (with the exception of medical emergencies). If you use non-network providers, you may have to pay the full cost for your care. You’re also required to have a primary care physician; if you need to see a specialist, you’ll need to a get a referral from your primary care doctor first.


Special Election Period: Generally, once you enroll into a Medicare Advantage plan, you stay enrolled in the plan until the next Annual Election Period (AEP) opens. However, there are some life events that might qualify you for a Special Election Period (SEP) during other times of the year, so you can make a change to your Medicare Advantage coverage. Some examples of these life events include (but aren’t limited to):
Every person is different, so you’ll want to carefully research Medicare Advantage plan options in light of your specific health needs and budget. Keep in mind that plan costs, benefits, service areas, and provider networks may all change from year to year, so it’s a good idea to review your coverage every year and make sure it’s still a good fit for your situation. Taking the time to shop around and compare Medicare Advantage plan options in your area could save you money on out-of-pocket costs.
During Open Enrollment, you may enroll your domestic partner, and your partner’s eligible dependents, in health and welfare benefits that are open for enrollment as long as the relationship meets established criteria. If you would like to enroll your newly-eligible domestic partner in Life and/or Accidental Death & Dismemberment (AD&D) insurance, or increase your own Life coverage, you will have a Period of Initial Enrollment from Jan. 1-31, 2019. See your benefits portal for details.

When you apply for Medicare, you can sign up for Part A (Hospital Insurance) and Part B (Medical Insurance). Because you must pay a premium for Part B coverage, you can turn it down. However, if you decide to enroll in Part B later on, you may have to pay a late enrollment penalty for as long as you have Part B coverage. Your monthly premium will go up 10 percent for each 12-month period you were eligible for Part B, but didn’t sign up for it, unless you qualify for a special enrollment period.
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