Tufts Health Unify, our Medicare-Medicaid One Care plan for people ages 21 – 64, gives you access to a network of providers, a dedicated care manager, a personalized care plan, and much more. You may be eligible for Tufts Health Unify if you live in Suffolk or Worcester counties of Massachusetts, are between the ages of 21 and 64, and are now enrolled in both Medicare and MassHealth.
The Patient Protection and Affordable Care Act ("PPACA") of 2010 made a number of changes to the Medicare program. Several provisions of the law were designed to reduce the cost of Medicare. The most substantial provisions slowed the growth rate of payments to hospitals and skilled nursing facilities under Parts A of Medicare, through a variety of methods (e.g., arbitrary percentage cuts, penalties for readmissions).
A federal law passed in 2003 created a “competition” requirement for Medicare Cost plans, which stipulated the plans could not be offered in service areas where there was significant competition from Medicare Advantage plans. Congress delayed implementation of the requirement several times until a law passed in 2015 that called for the rule to take effect in 2019.
Because the federal government is legally obligated to provide Medicare benefits to older and disabled Americans, it cannot cut costs by restricting eligibility or benefits, except by going through a difficult legislative process, or by revising its interpretation of medical necessity. By statute, Medicare may only pay for items and services that are "reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member", unless there is another statutory authorization for payment. Cutting costs by cutting benefits is difficult, but the program can also achieve substantial economies of scale in terms of the prices it pays for health care and administrative expenses—and, as a result, private insurers' costs have grown almost 60% more than Medicare's since 1970.[Original research?] Medicare's cost growth is now the same as GDP growth and expected to stay well below private insurance's for the next decade.
A Medicare Advantage plan is a private Medicare insurance plan that you may join as an alternative to Medicare. When you do, Medicare pays the plan a fee every month to administer your Part A and B benefits. You must continue to stay enrolled in both Medicare Part A and B while enrolled in your Medicare Advantage plan. Medicare pays the Medicare Advantage company on your behalf to take on your medical risk. This is how Medicare Advantage plans are funded.
Would you like to learn more about Medicare Advantage plans in your area? Ask me about anything else you’d like to know. You can use one of the links below to set aside some time to talk with me by phone, or ask me to email you with more information. Learn more about who I am by clicking my photo or profile below. If you want to start comparing the plans available in your area, click the Find Plans or Compare Plans buttons on this page.
The Minnesota Department of Health offers information about Medicare plans in Minnesota. The agency serves as a resource for those who need help paying their Medicare premiums and those interested in obtaining prescription drug coverage. The office also offers guidelines for handling complaints about health-care coverage and providers. Information on other types of health-care coverage are also covered by this website, including long-term care insurance. Downloads of publications on specific topics are also available, as well as links to additional resources available through state and federal offices.
Medicare Advantage plans have lock-in periods. You can enroll in one during Initial Enrollment Period when you first turn 65. After that, you may enroll or dis-enroll only during certain times of year. Once you enroll in Medicare Advantage, you must stay enrolled in the plan for the rest of the calendar year. You may only dis-enroll from an Advantage plan during specific times of the year.
As you might be aware, the Part D coverage gap, also known as the donut hole, is with us for one more year. The new healthcare law is gradually doing away with the coverage gap. Until the donut hole is gone for good in 2020, you can save money on prescriptions that are not covered by a Minnesota PDP by downloading a Pharmacy Discount Card or coupons. We recommend GoodRx.com.
Part A covers inpatient hospital stays where the beneficiary has been formally admitted to the hospital, including semi-private room, food, and tests. As of January 1, 2018, Medicare Part A has an inpatient hospital deductible of $1340, coinsurance per day as $335 after 61 days confinement within one "spell of illness", coinsurance for "lifetime reserve days" (essentially, days 91-150) of $670 per day, and coinsurance in an Skilled Nursing Facility (following a medically necessary hospital confinement of 3 night in row or more) for days 21-100 of $167.50 per day (up to 20 days of SNF confinement have no co-pay) These amounts increase or decrease yearly on 1st day of the year.
If you received an error when returning to your Online Benefit Application on or after September 29, you can reenter your saved application by creating or signing in to your my Social Security account. Additionally, beginning October 24, you can reenter your application from this page. If you are still unable to return to your application, please contact us. We apologize for any inconvenience.