A: In the initial phase of Part D coverage, you pay roughly 25 percent of the plan's cost for the drug. When you and the drug plan have paid a total of $3,700 for drugs in 2017, you enter the coverage gap or doughnut During this second phase, you will pay no more than 40 percent of the plan's price for a brand-name drug and 51 percent for a generic drug. — Read Full Answer
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A 2001 study by the Government Accountability Office evaluated the quality of responses given by Medicare contractor customer service representatives to provider (physician) questions. The evaluators assembled a list of questions, which they asked during a random sampling of calls to Medicare contractors. The rate of complete, accurate information provided by Medicare customer service representatives was 15%. Since then, steps have been taken to improve the quality of customer service given by Medicare contractors, specifically the 1-800-MEDICARE contractor. As a result, 1-800-MEDICARE customer service representatives (CSR) have seen an increase in training, quality assurance monitoring has significantly increased, and a customer satisfaction survey is offered to random callers.
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.
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.
† Medicaid is a federal program providing health coverage to eligible low-income children and families; Medi-Cal is California's Medicaid program. CHIP (Children’s Health Insurance Program) is a federal program providing coverage to children/youth up to age 19 in families with incomes too high to qualify them for Medicaid, but too low to afford private coverage. California’s CHIP program was called the Healthy Families Program (HFP). Although California continues to receive CHIP funding, in 2013 HFP enrollees were transitioned into Medi-Cal.
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.
Children with health insurance are more likely to receive needed medical care, are less likely to have costly hospitalizations, and tend to perform better in school than their uninsured peers (1). Providing quality, accessible, and affordable health care to all children requires comprehensive insurance coverage and an appropriately trained and compensated provider base including a sufficient number of subspecialists; it also requires effective systems of care including medical homes and parental understanding about what care is needed and how to obtain it (2, 3, 4). Immigrant children, especially those with undocumented parents or those who are themselves undocumented, are at particular risk of being uninsured and without regular health care (2, 5).
There is some evidence that claims of Medigap's tendency to cause over-treatment may be exaggerated and that potential savings from restricting it might be smaller than expected. Meanwhile, there are some concerns about the potential effects on enrollees. Individuals who face high charges with every episode of care have been shown to delay or forgo needed care, jeopardizing their health and possibly increasing their health care costs down the line. Given their lack of medical training, most patients tend to have difficulty distinguishing between necessary and unnecessary treatments. The problem could be exaggerated among the Medicare population, which has low levels of health literacy.[full citation needed]
Under the 2003 law that created Medicare Part D, the Social Security Administration offers an Extra Help program to lower-income seniors such that they have almost no drug costs; in addition approximately 25 states offer additional assistance on top of Part D. It should be noted again for beneficiaries who are dual-eligible (Medicare and Medicaid eligible) Medicaid may pay for drugs not covered by Part D of Medicare. Most of this aid to lower-income seniors was available to them through other programs before Part D was implemented.
Public Part C Medicare Advantage and other Part C health plans are required to offer coverage that meets or exceeds the standards set by Original Medicare but they do not have to cover every benefit in the same way. After approval by the Centers for Medicare and Medicaid Services, if a Part C plan chooses to pay less than Original Medicare for some benefits, such as Skilled Nursing Facility care, the savings may be passed along to consumers by offering even lower co-payments for doctor visits.
Each Advantage plan has its own summary of benefits. This summary will tell you what your copays will be for various healthcare services. Your plan will offer all the same services as Original Medicare, such as doctor visits, surgeries, labwork and so on. You might pay $10 to see a primary care doctor. Specialists will often be more – a $50 specialist copay is quite common. Some of the higher copays may come in for diagnostic imaging, hospital stay, and surgeries.
If you enroll in one right out of the gate at age 65, you need to be sure you want this coverage long-term. Your open enrollment window to get a Medigap plan with no health questions ends at 6 months past your Part B effective date. You might not be able to get a Medigap plan later if you have health conditions because applying for Medigap later will require you answer medical questions. You can be turned down for Medigap at that point if you are not healthy enough to qualify.
The Chief Actuary of the CMS must provide accounting information and cost-projections to the Medicare Board of Trustees to assist them in assessing the program's financial health. The Board is required by law to issue annual reports on the financial status of the Medicare Trust Funds, and those reports are required to contain a statement of actuarial opinion by the Chief Actuary.