This measure, established under the Medicare Modernization Act (MMA), examines Medicare spending in the context of the federal budget. Each year, MMA requires the Medicare trustees to make a determination about whether general fund revenue is projected to exceed 45 percent of total program spending within a seven-year period. If the Medicare trustees make this determination in two consecutive years, a "funding warning" is issued. In response, the president must submit cost-saving legislation to Congress, which must consider this legislation on an expedited basis. This threshold was reached and a warning issued every year between 2006 and 2013 but it has not been reached since that time and is not expected to be reached in the 2016-2022 "window." This is a reflection of the reduced spending growth mandated by the ACA according to the Trustees.

These coverage gaps mean that a particularly bad health year could leave you with tens of thousands of dollars in hospital bills. That's why most people purchase  Medicare supplement insurance – also called Medigap – or enroll in Part C, a Medicare Advantage Health Plan. Both options are offered by private insurance companies. They do, however, have to follow Medicare guidelines in what they are allowed to sell.
There are other proposals for savings on prescription drugs that do not require such fundamental changes to Medicare Part D's payment and coverage policies. Manufacturers who supply drugs to Medicaid are required to offer a 15 percent rebate on the average manufacturer's price. Low-income elderly individuals who qualify for both Medicare and Medicaid receive drug coverage through Medicare Part D, and no reimbursement is paid for the drugs the government purchases for them. Reinstating that rebate would yield savings of $112 billion, according to a recent CBO estimate.[138]

Medicare differs from private insurance available to working Americans in that it is a social insurance program. Social insurance programs provide statutorily guaranteed benefits to the entire population (under certain circumstances, such as old age or unemployment). These benefits are financed in significant part through universal taxes. In effect, Medicare is a mechanism by which the state takes a portion of its citizens' resources to guarantee health and financial security to its citizens in old age or in case of disability, helping them cope with the enormous, unpredictable cost of health care. In its universality, Medicare differs substantially from private insurers, which must decide whom to cover and what benefits to offer to manage their risk pools and guarantee their costs don't exceed premiums.[citation needed]
Choice: Medicare Advantage plans generally limit you to the doctors and facilities within the HMO or PPO, and may or may not cover any out-of-network care. Traditional Medicare and Medigap policies cover you if you go to any doctor or facility that accepts Medicare. If you require particular specialists or hospitals, check whether they are covered by the plan you select.
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):
Public Part C Medicare Advantage health plan members typically usually also pay a monthly premium in addition to the Medicare Part B premium to cover items not covered by traditional Medicare (Parts A & B), such as the OOP limit, self-administered prescription drugs, dental care, vision care, annual physicals, coverage outside the United States, and even gym or health club memberships as well as—and probably most importantly—reduce the 20% co-pays and high deductibles associated with Original Medicare.[43] But in some situations the benefits are more limited (but they can never be more limited than Original Medicare and must always include an OOP limit) and there is no premium. In some cases, the sponsor even rebates part or all of the Part B premium, though these types of Part C plans are becoming rare.

This measure, established under the Medicare Modernization Act (MMA), examines Medicare spending in the context of the federal budget. Each year, MMA requires the Medicare trustees to make a determination about whether general fund revenue is projected to exceed 45 percent of total program spending within a seven-year period. If the Medicare trustees make this determination in two consecutive years, a "funding warning" is issued. In response, the president must submit cost-saving legislation to Congress, which must consider this legislation on an expedited basis. This threshold was reached and a warning issued every year between 2006 and 2013 but it has not been reached since that time and is not expected to be reached in the 2016-2022 "window." This is a reflection of the reduced spending growth mandated by the ACA according to the Trustees.
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.[158] 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.[159] 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]
If you meet the requirements for both Medicare and Medicaid (aka, dual eligible or Medi-Medi) in Minnesota, you will automatically receive a Medicare Prescription Drug Plan, as well as Extra Help from Social Security. If you qualify for Extra Help, the program will cover most of the costs of your prescriptions. Even if you qualify, the dual eligible option may not suit your needs. In this case, enroll in the prescription drug plan of your choice. If you receive Medicaid now, call your local Medicaid office for assistance with your dual eligible benefits.
Sicker people and people with higher medical expenditures are more likely to switch from Medicare Advantage plans to Original Medicare. This statistic is primarily driven by people on Medicaid in custodial care at nursing home; such people no longer have need of any Medicare supplement, either a public Part C plan or a private Medigap or group retirement plan.[15] The Part C risk adjusted payments to Medicare Advantage plans are designed to limit this churn between types of Medicare (managed vs. FFS), but it is unclear how effective that policy is.[16]
If you enroll within 30 days following your 65th birthday, or if you have 6 months of continuous prior coverage, the 6-month waiting period for pre-existing conditions will be waived. Pre-existing conditions are conditions for which medical advice was given, or treatment was recommended by or received from a physician within six months before the effective date of coverage. If you wait until after the deadline to enroll, you may have a waiting period for pre-existing conditions and may have to complete a medical questionnaire.
The initial enrollment period is the best time for applicants to fill out their Medicare health insurance application to avoid late fees. Another time that applicants can register for Medicare is during the annual Minnesota Medicare enrollment period. The annual enrollment period begins at the same time each year. It officially starts on January 1 and goes until the very end of March. Certain enrollees might also have to pay a small late fee penalty for not enrolling during the MN initial enrollment period. Any applicants that enroll after this time will have to wait even longer for their coverage to begin, and they will have to pay an additional late penalty. Find out how you can obtain affordable private coverage and get a free health insurance quote by calling our toll-free number today.
Final decisions haven’t been made on exactly which counties in Minnesota will lose Cost plans next year, the government said. But based on current figures, insurance companies expect that Cost plans are going away in 66 counties across the state including those in the Twin Cities metro. They are expected to continue in 21 counties, carriers said, plus North Dakota, South Dakota and Wisconsin.

Part C sponsors annually submit bids that allow them to participate in the program. All bids that meet the necessary requirements are accepted. The bids are compared to the pre-determined benchmark amounts set, which are the maximum amount Medicare will pay a plan in a given county, by law. If a plan's bid is higher than the benchmark, enrollees pay the difference between the benchmark and the bid in the form of a monthly premium, in addition to the Medicare Part B premium. (Because of the county-specific nature of the framework and the bidding process leading to these differences, the same sponsor might offer the same benefits under the same brandname in adjacent counties at different prices.) If the bid is lower than the benchmark, the plan and Medicare share the difference between the bid and the benchmark; the plan's share of this amount is known as a "rebate," which must be used by the plan's sponsor to provide additional benefits or reduced costs to enrollees. A rebate cannot contribute to "profit" ("profit" is in quotes because most Medicare Advantage plans are administered by non-profit organizations, primarily integrated health delivery systems).


The Medicare-Choices email list is designed to help health insurance counselors, volunteers, attorneys, providers, consumers or other interested parties find resources, receive up-to-date information about Medicare, Medicare Advantage, Medicare Part D, Medicare Advantage, Medical Assistance, Minnesota Long-term Care Partnership or other related public or private benefits.

Several measures serve as indicators of the long-term financial status of Medicare. These include total Medicare spending as a share of gross domestic product (GDP), the solvency of the Medicare HI trust fund, Medicare per-capita spending growth relative to inflation and per-capita GDP growth; general fund revenue as a share of total Medicare spending; and actuarial estimates of unfunded liability over the 75-year timeframe and the infinite horizon (netting expected premium/tax revenue against expected costs). The major issue in all these indicators is comparing any future projections against current law vs. what the actuaries expect to happen. For example, current law specifies that Part A payments to hospitals and skilled nursing facilities will be cut substantially after 2028 and that doctors will get no raises after 2025. The actuaries expect that the law will change to keep these events from happening.
Generally, if you already receive Social Security payments, at age 65 you are automatically enrolled in Medicare Part A (Hospital Insurance). In addition, you are generally also automatically enrolled in Medicare Part B (Medical Insurance). If you choose to accept Part B you must pay a monthly premium to keep it. However, you may delay enrollment with no penalty under some circumstances, or with penalty under other circumstances.

That’s what the Medicare Part C (Medicare Advantage) program is all about: it gives you an alternative way to receive your Original Medicare (Part A and Part B) coverage (everything except hospice care, which Part A still covers). Some Medicare Advantage plans include additional benefits as well – prescription drug coverage, for example, or routine dental services and/or fitness programs. These are just a few examples of additional benefits that some Medicare Advantage plans offer – benefits not included in Original Medicare.
Some "hospital services" can be done as inpatient services, which would be reimbursed under Part A; or as outpatient services, which would be reimbursed, not under Part A, but under Part B instead. The "Two-Midnight Rule" decides which is which. In August 2013, the Centers for Medicare and Medicaid Services announced a final rule concerning eligibility for hospital inpatient services effective October 1, 2013. Under the new rule, if a physician admits a Medicare beneficiary as an inpatient with an expectation that the patient will require hospital care that "crosses two midnights," Medicare Part A payment is "generally appropriate." However, if it is anticipated that the patient will require hospital care for less than two midnights, Medicare Part A payment is generally not appropriate; payment such as is approved will be paid under Part B.[26] The time a patient spends in the hospital before an inpatient admission is formally ordered is considered outpatient time. But, hospitals and physicians can take into consideration the pre-inpatient admission time when determining if a patient's care will reasonably be expected to cross two midnights to be covered under Part A.[27] In addition to deciding which trust fund is used to pay for these various outpatient vs. inpatient charges, the number of days for which a person is formally considered an admitted patient affects eligibility for Part A skilled nursing services.
If you decide to leave a Medicare Advantage plan and return back to Original Medicare, you must notify your Medicare Advantage plan carrier. Otherwise Medicare will continue to show that you are enrolled in the Advantage plan instead of Medicare. This is a common billing nightmare that we see among people who enrolled on their own without the help of an agent.

Medicare Part C is available through Medicare Advantage plans, and is an alternative to Original Medicare (Part A and Part B). Medicare Advantage plans are health insurance plans offered by private health insurance companies approved by Medicare. Medicare Advantage health plans (such as HMOs and PPOs) are legally required to offer at least the same benefits as Original Medicare, but can include additional coverage as well, such as routine vision or dental benefits, health wellness programs, or prescription drugs.
As part of a broad set of overall reforms aimed to control the total cost of Medicare (e.g., large cuts in hospital and skilled nursing facility payments under Part A; adding surtaxes to Part D), the Patient Protection and Affordable Care Act (ACA) changed Trustee payments to Medicare Advantage and other Part C plans—versus what they otherwise would have been—by adjusting the way the statutory county benchmarks that kick off the annual Part C Medicare Advantage bidding process were calculated. The intention was to bring the capitated payments closer to the average costs of care per person under Original Medicare.
Original Medicare provides no similar OOP spending cap and the exposure of an Original Medicare beneficiary to a financial catastrophe is unlimited (but also rare). Once the OOP maximum is reached for an individual, the plan pays 100% of medical services for the remainder of the calendar year (with no lifetime maximum). This OOP limit does not apply to a Part C plan's Part-D-like self-administered drug coverage (which uses another means of addressing catastrophic costs).
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
Medicare beneficiaries in Minnesota have the option to enroll in a Medicare Advantage plan as an alternative way to get their Original Medicare, Part A and Part B, coverage. Also known as Medicare Part C, Medicare Advantage plans are available through private insurance companies that contract with Medicare. All Medicare Advantage plans are required to provide at least the same level of coverage as Original Medicare, meaning you’ll get the same hospital and medical benefits of Part A and Part B through your Medicare Advantage plan. In addition, some Medicare Advantage plans may also offer additional benefits, such as routine dental, vision, hearing, or prescription drugs.
Medi-Cal is California’s state-managed version of Medicaid, a federal health insurance program designed for low-income individuals and families. It provides low-cost and no-cost health insurance coverage to individuals and families that meet certain eligibility requirements.* Those who qualify for Medi-Cal coverage can continue to receive those benefits as long as they meet eligibility requirements.
One convenient way for children and youth to access needed services is through school-based health centers (SBHCs). These centers, whether located on school property or in the vicinity of a school, offer a range of services to underserved or uninsured students, such as primary medical care, mental or behavioral health care, dental care, substance abuse services, and health and nutrition education. More than 2,300 SBHCs operate nationwide (4). These centers have become a key part of the health care delivery system, as children and youth spend a significant amount of time at school, and barriers such as transportation and scheduling are reduced. SBHCs can lead to improved access to medical and dental care, health outcomes, and school performance (5, 6). They also reduce emergency room visits and health care costs (5, 6).
Increased access channels for new applications and additional eligibility verification resources helped increase enrollment following ACA implementation. Increased promotion through health fairs and community events as well partnership with other agencies have contributed to eligible individuals learning about and enrolling in Medi-Cal, as have targeted enrollment efforts such as assisting jail inmates in applying for coverage prior to reentry, use of community based organizations (CBOs) to assist clients in applying online, and placing HSA staff in the community to conduct outreach and enrollment.
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%.[99] 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.
Annual Election Period: The Annual Election Period (AEP) is October 15 through December 7 every year. The plan coverage you choose during the AEP begins on January 1 of the next year. It allows Medicare beneficiaries to add, change, or drop their current coverage. You can use this period to enroll into a Medicare Advantage or Medicare Prescription Drug Plan or switch plans. If you’re already enrolled into a Medicare plan, you can use this period to disenroll from your plan.
We provide our Q1Medicare.com site for educational purposes and strive to present unbiased and accurate information. However, Q1Medicare is not intended as a substitute for your lawyer, doctor, healthcare provider, financial advisor, or pharmacist. For more information on your Medicare coverage, please be sure to seek legal, medical, pharmaceutical, or financial advice from a licensed professional or telephone Medicare at 1-800-633-4227.
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.

Two distinct premium support systems have recently been proposed in Congress to control the cost of Medicare. The House Republicans' 2012 budget would have abolished traditional Medicare and required the eligible population to purchase private insurance with a newly created premium support program. This plan would have cut the cost of Medicare by capping the value of the voucher and tying its growth to inflation, which is expected to be lower than rising health costs, saving roughly $155 billion over 10 years.[125] Paul Ryan, the plan's author, claimed that competition would drive down costs,[126] but the Congressional Budget Office (CBO) found that the plan would dramatically raise the cost of health care, with all of the additional costs falling on enrollees. The CBO found that under the plan, typical 65-year-olds would go from paying 35 percent of their health care costs to paying 68 percent by 2030.[127]
In the 1970s, less than a decade after the beginning of fee for service Medicare, Medicare beneficiaries gained the option to receive their Medicare benefits through managed, capitated health plans, mainly HMOs, as an alternative to FFS Original Medicare, but only under random Medicare demonstration programs. The Balanced Budget Act of 1997 formalized the demonstration programs into Medicare Part C, introduced the term Medicare+Choice as a pseudo-brand for this option. Initially, fewer insurers participated than expected, leading to little competition.[2] In a 2003 law, the capitated-fee benchmark/bidding process was changed effective in 2005 to increase insurer participation, but also increasing the costs per person of the program.

I also made a solemn promise to our great seniors to protect Medicare. That is why I am fighting so hard against the Democrats' plan that would eviscerate Medicare. Democrats have already harmed seniors by slashing Medicare by more than $800 billion over 10 years to pay for Obamacare. Likewise, Democrats would gut Medicare with their planned government takeover of American health care.


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.
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