© 2018 Blue Cross and Blue Shield of North Carolina. ®, SM Marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. Blue Cross NC is an abbreviation for Blue Cross and Blue Shield of North Carolina. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association.
The SFHP Service Center is a place where you can go to get information on health care access options that are available for you and your family. Our Enrollment Team is available, by appointment, to provide application assistance for the Medi-Cal, Healthy Kids HMO, Healthy San Francisco, and San Francisco City Option Programs. Learn more about our Service Center.
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.
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.
But that has not been the case at all. Medicare Advantage enrollment continues to grow each year. There were 19 million Advantage enrollees in 2017, which is about a third of all Medicare beneficiaries, who totaled about 58 million in 2017). The number of Medicare Advantage plans available has been fairly steady since 2011 (2,034 in 2016, up from 1,945 in 2015; but down from a high of 2,830 in 2009). The majority of beneficiaries still have at least one zero-premium plan available to them, and the average enrollee could select from among 21 plans in 2018, which was slightly higher than it had been at any point since 2011 (but this is still down significantly from 48 plans in 2009).
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.

Just to make life truly confusing, the various options offered by Medigap are also sorted by letter. Your choices are Plans A, B, C, D, F, G, K, L, M and N. What these plans include is standardized by Medicare. What you pay for them can vary, however, so it's worth shopping around. Joseph Graves, insurance agent and Founder of “I Hate Buying Insurance,” says many people enroll in Plan F, the most expensive choice, because it covers nearly all the gaps. A person with Plan F coverage will have few or no out-of-pocket expenses. A healthy person living in Florida would pay about $289 per month for Plan F coverage as of 2014, according to Graves.
On January 1, 1992, Medicare introduced the Medicare Fee Schedule (MFS), a list of about 7,000 services that can be billed for. Each service is priced within the Resource-Based Relative Value Scale (RBRVS) with three Relative Value Units (RVUs) values largely determining the price. The three RVUs for a procedure are each geographically weighted and the weighted RVU value is multiplied by a global Conversion Factor (CF), yielding a price in dollars. The RVUs themselves are largely decided by a private group of 29 (mostly specialist) physicians—the American Medical Association's Specialty Society Relative Value Scale Update Committee (RUC).[54]
Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract. Enrollment in the plan depends on the plan’s contract renewal with Medicare. UnitedHealthcare Insurance Company pays royalty fees to AARP for use of its intellectual property. These fees are used for the general purposes of AARP. AARP and its affiliates are not insurers. You do not need to be an AARP member to enroll.
The name "Medicare" was originally given to a program providing medical care for families of individuals serving in the military as part of the Dependents' Medical Care Act, which was passed in 1956.[4] President Dwight D. Eisenhower held the first White House Conference on Aging in January 1961, in which creating a health care program for social security beneficiaries was proposed.[5][6] In July 1965,[7] under the leadership of President Lyndon Johnson, Congress enacted Medicare under Title XVIII of the Social Security Act to provide health insurance to people age 65 and older, regardless of income or medical history.[8][9] Johnson signed the bill into law on July 30, 1965 at the Harry S. Truman Presidential Library in Independence, Missouri. Former President Harry S. Truman and his wife, former First Lady Bess Truman became the first recipients of the program.[10] Before Medicare was created, approximately 60% of people over the age of 65 had health insurance, with coverage often unavailable or unaffordable to many others, as older adults paid more than three times as much for health insurance as younger people. Many of this latter group (about 20% of the total in 2015) became "dual eligible" for both Medicare and Medicaid with passing the law. In 1966, Medicare spurred the racial integration of thousands of waiting rooms, hospital floors, and physician practices by making payments to health care providers conditional on desegregation.[11]
Part B also helps with durable medical equipment (DME), including canes, walkers, lift chairs, wheelchairs, and mobility scooters for those with mobility impairments. Prosthetic devices such as artificial limbs and breast prosthesis following mastectomy, as well as one pair of eyeglasses following cataract surgery, and oxygen for home use is also covered.[41]
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.
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.
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.
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.

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]
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.
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.

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.
LTSS and Waiver clients who live in non-MMAI counties cannot enroll in HealthChoice Illinois at this time. Please see the "LTSS and Waiver Clients in non-MMAI Delay Letter" on the Enrollment Materials page for details. It has been mailed to clients affected by this change. If you have questions about the letter, please call us. Click the button below for more. 
As of 2014, Medicare paid about $7,721 annually per enrollee in Minnesota. That’s according to a standardized spending report from CMS, which eliminates spending differences that stem from strictly geographic differences in costs (eg, higher labor costs or overhead expenses in higher cost-of-living areas). The report only considers spending in Original Medicare, as opposed to Medicare Advantage.
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.
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.
California's Medicaid program Medi-Cal is a public health insurance program that provides free or low-cost health care coverage to low-income individuals including families with children, seniors, persons with disabilities, children in foster care, pregnant women, single adults and low income people with specific diseases such as tuberculosis, breast cancer or HIV/AIDS. Medi-Cal pays for medical visits, hospital care, prescription drugs, pregnancy-related treatment, dental and eye care, and other medical services for individuals who do not have healthcare coverage.
A: In 2017, most Medicare beneficiaries can choose from a variety of plans from at least six insurance companies. The plans may have different provider networks, cover different drugs at different pharmacies, and can charge different monthly premiums, annual deductibles, and copayments or coinsurance for hospital and nursing home stays, and other services.  — Read Full Answer
The name "Medicare" was originally given to a program providing medical care for families of individuals serving in the military as part of the Dependents' Medical Care Act, which was passed in 1956.[4] President Dwight D. Eisenhower held the first White House Conference on Aging in January 1961, in which creating a health care program for social security beneficiaries was proposed.[5][6] In July 1965,[7] under the leadership of President Lyndon Johnson, Congress enacted Medicare under Title XVIII of the Social Security Act to provide health insurance to people age 65 and older, regardless of income or medical history.[8][9] Johnson signed the bill into law on July 30, 1965 at the Harry S. Truman Presidential Library in Independence, Missouri. Former President Harry S. Truman and his wife, former First Lady Bess Truman became the first recipients of the program.[10] Before Medicare was created, approximately 60% of people over the age of 65 had health insurance, with coverage often unavailable or unaffordable to many others, as older adults paid more than three times as much for health insurance as younger people. Many of this latter group (about 20% of the total in 2015) became "dual eligible" for both Medicare and Medicaid with passing the law. In 1966, Medicare spurred the racial integration of thousands of waiting rooms, hospital floors, and physician practices by making payments to health care providers conditional on desegregation.[11]
×