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.
You will pay one-half of the cost-sharing of some covered services until you reach the annual out-of-pocket limit of $5240 each calendar year. However, this limit does NOT include charges from your provider that exceed Medicare-approved amounts (these are called “Excess Charges”) and you will be responsible for paying this difference in the amount charged by your provider and the amount paid by Medicare for the item or service.
Minnesota Medicare claims are generally not filed by beneficiaries. MN Medicare claim forms must often be filed out by doctors and medical providers. A Medicare claim can be made within a year of first receiving the provided service. It is still possible to file claims after this time period, but Medicare is in no way legally obligated to make any payments. Beneficiaries might get lucky, especially if there were extenuating circumstances for why they were unable to file a Medicare claim in the first place.

Jump up ^ Frakt, Austin (December 16, 2011). "Premium support proposal and critique: Objection 4, complexity". The Incidental Economist. Retrieved October 20, 2013. [...] Medicare is already very complex, some say too complex. There is research that suggests beneficiaries have difficulty making good choices among the myriad of available plans. [...]
Popular opinion surveys show that the public views Medicare's problems as serious, but not as urgent as other concerns. In January 2006, the Pew Research Center found 62 percent of the public said addressing Medicare's financial problems should be a high priority for the government, but that still put it behind other priorities.[90] Surveys suggest that there's no public consensus behind any specific strategy to keep the program solvent.[91]
Notice: When your Medicare Part A hospital benefits are exhausted, the insurer stands in the place of Medicare and will pay whatever amount Medicare would have paid for up to an additional 365  days as provided in the policy’s “Core Benefits.” During this time the hospital is prohibited from billing you for the balance based on any difference between its billed charges and the amount Medicare would have paid.
People often ask us our opinion on which plan is the best Medicare Advantage plan. This varies based on a number of personal factors. What’s right for your friend or neighbor may not be right for you. Don’t risk making a mistake on something as critical as your health insurance. Get help from an experienced agent who can explain your options in detail.

What Medicare covers in Minnesota is determined entirely by the plan. Medicare Part A coverage is focused primarily on hospital insurance. Some of the services that are covered by Medicare Part A include inpatient hospital care, some nursing facility costs, limited home health services, and some hospice cares. The most important factor for determining Medicare Part A coverage in Minnesota is whether or not a doctor recommended it. For example, the coverage could extend to physical or occupational therapy, if recommended by a doctor. Anything that is not strictly recommended will not be covered.

The plan that was best for you over the past year may not be the best one next year. That may be because the drugs you take or the doctors you see have changed. Or it may be because the coverage has changed under your plan for next year—your drugs may be moving to a more expensive pricing tier with higher co-payments, or your doctors may be leaving your Medicare Advantage plan’s network. Or new plans may be introduced in your area that are a better match for you. Mutual of Omaha is entering the Part D market in several states, for example, and more insurers are introducing prescription drug plans or Medicare Advantage plans with lower premiums. Because you can change plans every year, you can focus specifically on your drugs and dosages or the type of health care you need now; you can switch again next year if your needs or your options change.


Jump up ^ Frakt, Austin (December 16, 2011). "Premium support proposal and critique: Objection 4, complexity". The Incidental Economist. Retrieved October 20, 2013. [...] Medicare is already very complex, some say too complex. There is research that suggests beneficiaries have difficulty making good choices among the myriad of available plans. [...]
This Medical Mutual of Ohio and its Family of Companies (collectively, “Medical Mutual”) website may contain links to other Internet sites (“Third Party Sites”) that are not maintained by or under the control of Medical Mutual. These links are provided solely for your convenience, and you access them at your own risk. Medical Mutual makes no warranties or representations about the contents of products, services or information offered in such Third Party Sites. Consequently, Medical Mutual is not and cannot be held responsible for the accuracy, copyright compliance, legality or decency of material contained in Third Party Sites linked to this Medical Mutual website.
Footnote: Medi-Cal is California's Medicaid program, which pays for medical services for children and adults with limited income and resources. Data for 2013 were preliminary as of August 2015. Data include children/youth enrolled in both Medi-Cal and Medicare. Figures may not match data by age and by race/ethnicity, which reflect average monthly enrollment over a fiscal year. Please visit the California Dept. of Health Care Services for more information.
Of the more than 300,000 people losing their Cost plans in Minnesota, it’s likely that roughly 100,000 people will be automatically enrolled into a comparable plan with their current insurer, Corson said, unless they make another selection. Details haven’t been finalized, he said. That likely will leave another 200,000 people, he said, who will need to be proactive to obtain new replacement Medicare coverage.
Now that you have an idea of the type of Medicare plan options for Minnesotans, would you like some assistance looking for a plan that fits? I’d be happy to help, and you can click on the “View profile” link below to view my profile if you’d like. How about setting up a phone call with me, or having me send you some information by email? You can click on the links below to do that. Some folks prefer to research plans on their own; you can do that easily by clicking on the Compare Plans option on the right.

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.[72] 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.[citation needed][Original research?][73] Medicare's cost growth is now the same as GDP growth and expected to stay well below private insurance's for the next decade.[74]


Plans are required to limit out-of-pocket (OOP) spending by a beneficiary for Parts A and B to no more than $6,700 (as of 2016) per year for in-network providers. The OOP limit may be higher for out of network providers in a PPO; out of network providers are typically not permitted in an HMO. The average OOP limit in 2016 was around $5000. Note that an OOP limit is not a deductible as is often reported; it is instead a financial-protection benefit. It is rare for a Medicare Advantage beneficiary to reach the annual OOP limit.
Medicare Advantage offers health benefits for Medicare beneficiaries through private plans instead of through Original — or traditional — Medicare (the federal government’s fee-for-service program). These plans are one option for consumers who desire additional benefits beyond what Original Medicare offers, but are not considered a wise option by some consumers who are concerned that government spends more per enrollee on the private plans than it does on Original Medicare. Medicare Advantage plans are available with no premium other than the cost of Part B, but they also have provider networks that are more limited than Original Medicare, and total out-of-pocket costs can be considerably higher than enrollees would pay if they had Original Medicare plus a Part D plan plus Medigap.
Without question, Original Medicare with a Medigap plan gives you very comprehensive coverage. The primary differences are that with Medigap plans, you can see any doctor that accepts Medicare. You don’t have to ask your doctors if they take your specific Medigap insurance company. The network is Medicare, which has over 800,000 providers. The network is nationwide, not local.
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]
Jump up ^ Frakt, Austin (December 13, 2011). "Premium support proposal and critique: Objection 1, risk selection". The Incidental Economist. Retrieved October 20, 2013. [...] The concern is that private plans will find ways to attract relatively healthier and cheaper-to-cover beneficiaries (the "good" risks), leaving the sicker and more costly ones (the "bad" risks) in TM. Attracting good risks is known as "favorable selection" and attracting "bad" ones is "adverse selection." [...]
Evidence is mixed on how quality and access compare between Medicare Advantage and "traditional" Medicare.[17] ("traditional" in quotes because it is not the same as Original Medicare; everyone in Medicare must begin by joining Original Medicare; the term "traditional" typically refers to FFS and almost always means the beneficiary has a private group or individually purchased supplement to Original Medicare). Most research suggests that enrollees in Medicare HMOs tend to receive more preventative services than beneficiaries in traditional Medicare; however, beneficiaries, especially those in poorer health, tend to rate the quality and access to care in traditional Medicare more favorably than in Medicare Advantage. It is difficult to generalize the results of studies across all plans participating in the program because performance on quality and access metrics varies widely across the types of Medicare Advantage plans and among the dozens of providers of Medicare Advantage plans.
As a result, an estimated 320,000 Medicare Cost enrollees in Minnesota need new coverage for 2019. There are 21 counties where Medicare Cost plans will continue to be available, but Medicare Cost enrollees in the remaining counties cannot keep their Cost plans. Instead, they can either enroll in a Medicare Advantage plan (some will be automatically enrollees in a comparable Medicare Advantage plan, although they’ll have an option to pick something else instead), or select a Medigap plan to supplement their Original Medicare (enrollees whose Medicare Cost plans are ending have guaranteed issue rights to a Medigap plan, so they can purchase one even if they have pre-existing medical conditions).
Private managed care programs for Medicare beneficiaries are particularly popular in Minnesota. More than half of all Minnesota Medicare enrollees are in Medicare Advantage plans, as opposed to a national average of 33 percent (in Minnesota, it’s 56 percent; Hawaii has the second-highest percentage of their Medicare beneficiaries covered by Medicare Advantage, at 45 percent).
Medicare Advantage plans are required to offer a benefit "package" that is at least equal to Original Medicare's and cover everything Medicare covers, but they may cover benefits in a different way. For example, plans that require higher out-of-pocket costs than Original Medicare for some benefits, such as skilled nursing facility care, might offer lower copayments for doctor visits to balance their benefits package.[11] CMS limits the extent to which plans' cost-sharing can vary from that of Original Medicare. Medicare Advantage plans that receive "rebates" or quality-based bonus payments are required to use the money to provide benefits not covered by Original Medicare.
If you are a Minnesota resident enrolled in Original Medicare (Part A and Part B), you have options to also enroll in a Medicare Supplement Insurance plan in Minnesota (also called Medigap or MedSupp) to cover health costs not covered under Original Medicare. Costs not covered under Original Medicare might include deductibles, copayments, coinsurance, and other out-of-pocket costs. Most states, including Minnesota, offer Medigap policies with letters corresponding with different Medicare Supplement Insurance plans with certain standardized benefits.
Out-of-network/non-contracted providers are under no obligation to treat Blue Cross NC members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. 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.

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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.

OptumRx is an affiliate of UnitedHealthcare Insurance Company. You are not required to use OptumRx home delivery for a 90-day supply of your maintenance medication. $0 copay may be restricted to particular tiers, preferred medications, or mail order prescriptions during the initial coverage phase and may not apply during the coverage gap or catastrophic stage.
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