Posted in Insurance

CHIP Funding Has Been Extended, What’s Next For Children’s Health Coverage?

After allowing funding for the Children’s Health Insurance Program (CHIP) to lapse for an unprecedented 114 days, Congress extended CHIP funding through federal fiscal year (FFY) 2023. On January 22, 2018, the President signed a continuing resolution approved by Congress that would end the 3-day government shutdown and adopt the Helping Ensure Access for Little Ones, Toddlers and Hopeful Youth by Keeping Insurance Delivery Stable Act (HEALTHY KIDS Act).

The delay in long term federal financing for what has been long touted as a popular bipartisan program had put families, state officials, and other stakeholders on edge, in some states more than others. What happened and what’s next for CHIP?

What Is CHIP?

The Children’s Health Insurance Program (CHIP) was enacted in 1997 to encourage states to expand access to affordable health coverage following a period when employer-sponsored insurance for children was on the decline and uninsured rates among children were on the rise. As an incentive, the federal government picks up a larger share of costs,historically ranging from 65 percent to 81 percent compared to 50 percent to 73 percent in Medicaid.

States also have more flexibility in designing their programs. Specifically, states may use CHIP funds to expand Medicaid for children (also known as M-CHIP), establish separate CHIP programs, or a combination of the two approaches. M-CHIP programs must follow the same rules as Medicaid with one exception—children must be uninsured. But separate CHIP programs have more flexibility in terms of benefits offered and cost-sharing required of families.

How Does CHIP Funding Work?

CHIP is a block grant program, meaning a fixed amount is appropriated for a set period of time and allocated to states in a specific manner. Congress must act periodically to extend funding for the program, which serves nearly nine million children and pregnant women annually. Each state receives an allotment based on projected expenditures. States generally have two years to spend their allotment and then unspent funds go into a redistribution pool, which is reserved to cover shortfalls states may experience.

So What’s In The Latest CHIP Funding Measure?

Funding for CHIP has been extended retroactively to October 1, 2017 through September 30, 2023. The HEALTHY KIDS Act provides annual allotments that increase from $21.5 billion in FFY 2018 to $25.9 billion in FFY 2023. Based on current spending levels and future projections, the funding is expected to be sufficient to cover the costs in all states. The act also extends the child enrollment contingency fund and addresses several key policy issues and related funding:

  • The MOE provision is extended through FFY 2023 but states may roll back eligibility to 300 percent of the federal poverty level (FPL) beginning in FFY 2020. Fourteen states including the District of Columbia (Alabama, Connecticut, District of Columbia, Hawaii, Illinois, Iowa, Maryland, New Hampshire, New Jersey, New York, Pennsylvania, Vermont, Washington, and Wisconsin) currently cover children above 300 percent of the FPL. Know more about the chip health insurance pa (Pennsylvania).
  • The temporary enhanced CHIP match is phased out in FFY 2021. In FFY 2016, the federal CHIP matching rate was increased by 23 percentage points to between 88 and 100 percent of CHIP costs to help states maintain recent improvements in children’s coverage while guaranteeing eligibility under the MOE. To give states time to plan for a resumption of regular CHIP matching rates, the HEALTHY KIDS Act maintains the bump as planned through FFY 2019 and cuts it in half to 11.5 percentage points in FFY 2020 before phasing it out completely in FFY 2021.
  • Express lane eligibility is extended through FFY 2023 allowing states to continue to use findings from other means-tested programs, like the Supplemental Nutrition Assistance Program (SNAP), to determine eligibility and enroll or renew coverage in Medicaid or CHIP for children.
  • Additional grant funding is available to continue to fight childhood obesity, provide outreach and enrollment grants to community-based organizations, and extend the pediatric quality measures program, which funds the centers of excellence to improve and strengthen pediatric quality measures.

What’s Next For CHIP?

  • CHIP buy-in programs are exempted from minimum essential coverage requirements and can be rated as part of a shared risk pool with CHIP. States with CHIP buy-in programs allow families with income above the CHIP limits to purchase CHIP coverage at full cost, in most cases. CHIP programs are automatically considered to meet minimal essential coverage (MEC) standards but because buy-in programs are not considered part of CHIP they were required to make changes to become MEC compliant like private insurance.
  • Going forward, the HEALTHY KIDS Act exempts CHIP buy-in or look-alike programs from MEC standards, meaning they can impose limitations like annual or lifetime limits if benefits are identical to CHIP. The HEALTHY KIDS Act also codifies the ability of states to develop the rate (or cost of coverage) for CHIP buy-in programs as part of a shared risk pool with the larger CHIP program. While CMS has previously maintained that there was no prohibition on risk pool sharing, this new provision explicitly addresses the issue.

There’s already talk of Congress coming back to extend CHIP for an additional four years. After an unprecedented lapse in funding, it would offer peace of mind to families knowing their children’s coverage is secure while giving states the predictability needed to manage their programs. Will a long-term extension of CHIP become a catalyst for states to do more to advance children’s coverage as it has in the past?

CHIP’s enactment in 1997 was accompanied by a new determination to expand children’s coverage. Over the years, states steadily increased participation of eligible uninsured children by pioneering innovations in enrollment and retention. Through a performance bonus program, the 2009 CHIP Re authorization Act incentivized states to increase enrollment of eligible children in Medicaid by removing red tape and simplifying the application and renewal processes. Adoption of these methods was accelerated by the ACA’s requirement for states to advance the use of electronic data to reduce paperwork and increase government efficiency.

But it’s critical to recognize that CHIP sits on the shoulders of Medicaid. For every child that relies on CHIP, four children are enrolled in Medicaid. As such, CHIP and Medicaid must work in tandem to advance coverage and improve access and the quality of care. As I noted in this September 2017 Health Affairs commentary, there is long list of actions states could take—starting with expanding eligibility in states with levels below the national median (255 percent of the FPL). Eliminating CHIP waiting periods and adopting 12 months or longer of continuous eligibility would get kids into care quicker and reduce churning on and off coverage. CHIP programs could improve coverage by adopting Medicaid’s benefit standard and the American Academy of Pediatricians Bright Futures Guidelines for preventive care. States could advance their quality improvement efforts by reporting the full Core Set of Children’s Health Care Quality Measures in Medicaid and CHIP.

But there is reason for concern as some states and the federal government take steps to chip away at Medicaid for low-income families. These efforts will undoubtedly spill over to negatively impact children by reversing the welcome mat effect that Medicaid expansion has had on children’s enrollment, not to mention improving parent health and family economic security. If the foundation of Medicaid that CHIP rests on is weakened, there is little doubt that the nation’s success in covering children will be at risk.

There is a key lesson to be taken from what happened to CHIP over the past four months. As a block grant program, CHIP’s lapse in funding does not bode well for Medicaid if it were to follow a similar model—as proposed during the attempts to not only repeal the ACA but also change the financing structure of Medicaid. CHIP is a popular program, enjoying bipartisan support. It has been adequately funded over its 20-year history and includes a contingency fund that provides shortfall funding in case enrollment costs exceed projections.

But even CHIP got caught up in partisan politics and states came perilously close to freezing new enrollment and disenrolling children. As for the Medicaid block grant proposals considered in 2017, they would not even adequately fund Medicaid based on future spending projections, as CHIP does. Rather, the proposals would have reduced federal funding, resulting in larger cuts over time and jeopardizing coverage for low-income families and adults.

Even if Medicaid’s guaranteed funding structure remains intact, will states use waivers to abandon the ACA’s streamlining goals and impose new barriers to coverage such as work requirements, lockouts for missing deadlines for payments and paper work, more frequent renewal cycles, and lifetime limits on benefits for parents and adults? A case in point is the Kentucky Medicaid waiver, which estimates that 100,000 people will lose coverage.

Ultimately, the courts will decide whether the Trump administration has the authority to approve these kinds of changes that clearly do not advance the goals of the Medicaid program to ensure that low income and vulnerable populations have access to health care. As these efforts dominate health news, less attention and fewer resources are focused on innovative ways to improve the quality of care and health outcomes for children who rely on public coverage.

So even though CHIP’s future looks rosy with a long-term, perhaps even 10-year, extension, it alone cannot protect the nation’s success in covering 95 percent of children. CHIP is indelibly linked to Medicaid, as is the future of children’s coverage.

Posted in Medicare

Important Medicare changes in 2020

If you are enrolling in Medicare this year, you must understand some significant changes that are happening to Medicare in 2020.

There are four big changes happening in 2020:

1: As you all know, most of you will pay nothing for Medicare Part A premiums, because you qualify through working at least 40-quarters. You have been “pre-paying” Part A premiums through payroll taxes.

However, Medicare Part B is a different story.

Medicare Part B covers your doctor’s visits, your lab test, your durable medical equipment, and things of that nature. Medicare Part B premiums are taken directly out of your Social Security check if you are claiming Social Security.

In 2019, the premium for Medicare Part B was $135.50 a month. However, effective on January 1, 2020, Medicare Part B will now cost $144.60 a month.

For those of you that are drawing Social Security, there is a rule called “hold harmless,” and it says that Medicare Part B can’t increase its rate more than your Social Security cost of living check increases.

2: Additionally, the deductible for Medicare Part B is increasing. In 2019, the Part B deductible was $185, and now in 2020, it increased to $198.

With all of this said, these increases will depend on which plan you have, whether it’s Original Medicare or Medicare Advantage, it may or may not impact you.

3: With all the changes to Part B, there is also a change to people who have higher incomes. The rule for 2020 states if your modified adjusted gross income is more than $87,011 filing as an individual, or $174,001 filing taxes as a couple, you will pay more for Medicare. This is slightly higher than the 2019 threshold.

4: Plan F is no longer available for people to join as of January 1, 2020. I talk about how this works in detail on my workshop and why this isn’t necessarily a bad thing, but if you were set on Plan F, you will need to find a different option.

As you approach this year and your Medicare decision, be sure to take into account these price increases.

Medicare is complicated, but it doesn’t have to be. At the Medicare Coach, we are truly independent. We don’t receive any money or commissions from insurance companies, and for that reason, our guidance and advice is unbiased.

To easily make your right Medicare decision, sign up for our blue cross medicare advantage. If you have any question consult with our experts, we feel happy to help you.

Posted in Medicare

Avoiding Medicare Fraud

Medicare fraud affects many seniors each year, with the number of affected seniors is on the rise. Medicare fraud is illegal, and an operation that seniors should report as soon as they suspect any foul play. Not only does it hurt Medicare’s operations, but it also hurts the seniors involved. There are many ways to stay protected from Medicare abuse and fraud, and all seniors should take part in these precautions.

Medicare Fraud

When talking about fraud, it can get complicated and extensive. However, Medicare fraud breaks down into a simple concept: Medicare fraud is the use of an individual’s Medicare information for personal gain. This type of fraud is always intentional in nature.

Medicare fraud can include:

  • The use of one’s Medicare status to get services or medications for another individual
  • Submitting false claims to get money
  • Using one’s Medicare card to gain health services

These are only a few of the ways that individuals can fall victim to Medicare fraud. Typically, there are multiple types of people who commit these offenses. These people could be looking for personal gain, or be groups or organizations looking to take advantage of exposed seniors. It doesn’t matter who commits these crimes; it is still a serious offense that can often lead to imprisonment.

Medicare Abuse

Slightly different from Medicare fraud, Medicare abuse is any questionable practice that results in unnecessary or unreasonable costs to Medicare. Usually, abuse refers and applies to falsified payments. This includes improper billing procedures or charging too much for services or supplies. If not caught in time, Medicare abuse can sometimes lead to Medicare fraud. Both situations are illegal and are punishable by law.

Avoiding Medicare Fraud and Medicare Abuse

To avoid Medicare fraud and abuse, the best way is to keep track of all your Medicare payments and transactions. These transactions include any goods or services you are receiving from Medicare, any payouts you have received, and any notices you get from an insurance company or Medicare. After you obtain these documents, make sure to review them. It will be evident if there is any abuse or fraud taking place. If there is, it is pertinent that you report it immediately.

Reporting Medicare Fraud and Medicare Abuse

If you notice that you might have fallen victim to a Medicare fraud or abuse scheme, you must report this to protect yourself financially and legally. There are multiple ways to report this illegal activity. However, before you report, you must have a specific set of information about the crime. This information includes:

  • Provider name or any ID number included on documents
  • The date of the fraudulent items or services
  • A list of the services or items in question
  • The date that appears on your MSN
  • Your name and your Medicare number
  • A detailed description of why you believe Medicare did not need to pay for your goods or services
  • Any additional information you might have

Additional Concerns

If you have any additional concerns or worries about Medicare fraud, please feel free to refer back to this article. If you have any signs that you are a victim of Medicare fraud, you must consult with medicare providers in pennsylvania as soon as possible to protect yourself. During the Medicare supplement buying process, we can assure you that your information is safe and confidential. We can help ease your worries during this process and prepare you for all potential scenarios.

Posted in Insurance

How To Get The Best Health Insurance For Your Family

Health insurance is incredibly important and for the sake of you and your family, it must be considered at some point. In general, most people already have some type of insurance, which is pretty good, but far from ideal, as you want to make sure the coverage is optimum. In order to check its quality, pay attention to the offered treatments, general availability and other factors you or your family members need. Don’t forget that if something isn’t covered by insurance, you will have to pay for it out of pocket.

With that said, choosing the best health insurance, especially the best private health insurance, will take some time. There are a lot of factors to take into consideration and there are a lot of variables which will change all the time. That’s why it is important to spend some time on research and get the right decision only when you are absolutely certain it is what you need. You should consider coverage of treatments needed by your or a family member. Some insurance plans offer them and some don’t. Also, keep in mind the future needs of yourself and your family. They are the main things to consider and to take into account.

Tips to take into consideration

There are a few tips you should take into account before you get your family health insurance. A family always starts from the existing youngest generation that is the children of the family and we should always keep them into consideration , also plan the health insurance for them accordingly. There are various kind of options available under child health insurance program , that serves uninsured children up to age 19 in families with compensation too high to even consider evening consider qualifying them for Medicaid. This can make a huge difference and are more important than you may believe.

Conditions that already exist

Be careful and pay attention to any pre-existing conditions your family member has. Some insurance plans are partially limited, which makes them not great for this type of user. Other plans are just perfect and they don’t come with any limitations. Obviously, the best time to get a medical insurance is when you are healthy.

Use of the policy

If you use your policy a few times per a year, then a lower premium policy is the best option. Why you would pay for higher values when you don’t actually need them? Also, keep in mind that you can increase the policy whenever you want.

Cost and coverage

Basically, this is how much you will pay and what you will get. Lower policies are more affordable, but you may have to pay for some treatments out of pocket. Others require more money to pay each month, but they offer better coverage. The balance you can find here is probably one of the best things to strive for in order to get the best medical insurance.


All limits refer to coverage. Some plans have severe limits, others don’t. Try to get a better idea regarding them before you start your policy use.


Essentially, you get what you pay for. If there are little to no medical complications in your family, you might be safe getting a cheap policy, but if anything happens there will be huge out of pocket costs. It’s best to find a happy medium in terms of cost and coverage. To know more about small business health insurance options please contact us in the comment section, we are here to help you.

Posted in Insurance

Retained Asset Accounts: Fact sheet

Background information

A Retained Asset Account is an account whose initial balance is a life insurance or annuity death benefit and that essentially operates like a checking account. Beneficiaries of life insurance death benefits may choose to take the money in several ways (in industry jargon, “settlement options”). Before 1984 the common (and default) choice was a check for the entire amount due to the beneficiary. However, understandably—considering the circumstances in which this money became available—many beneficiaries did not want to deal with death-related financial matters immediately. Sometimes they just put the check in a drawer and forgot about it or, if they cashed it, were sometimes unable to manage such large sums of money effectively and found that it quickly dissipated. As a result, beneficiaries looked to life insurers to create a way for them to keep their money safe and available until they were better able to use it. The new settlement option, established in 1984 and generally known in the industry as a Retained Asset Account, meets these goals. In effect, it creates a checking account whose initial balance is the death benefit. The principal and a minimum rate of interest are both guaranteed by the insurer. Additional interest is credited to the account at a rate declared by the insurer; the credited rate is comparable to that paid in similar accounts offered by banks and money-market mutual funds. Beneficiaries get free checks and periodic reports on the status of their account.

Frequently Asked Questions

Is a retained asset account in an FDIC-insured bank?

No. As with other life insurance settlement options, the money stays with the life insurer. However, the money is protected and the beneficiary has full access to the funds at all times. The money is as safe, perhaps even safer, with the insurer than with a bank, even taking into account FDIC insurance. That is because: (a) historically, many more banks have failed than insurers; and (b) there is a state guaranty fund system that insures at least as much as or more than the FDIC does. In many states the insurer guarantees are up to $300,000 (in some states as high as $500,000), whereas the FDIC insurance limit is $250,000 (recently raised from $100,000). No one has ever lost a cent in a retained asset account, but the same cannot be said for bank accounts that exceeded the FDIC limits or most other investment accounts. Moreover, as long as the death benefit remains with the life insurer, it is beyond the reach of the beneficiary’s creditors. Once the money is released by the insurer, the creditor protection no longer applies. A bank’s name may be associated with the account because some life insurers use banks to administer the account; however this does not mean that it is in an FDIC-insured bank.  

How long must the money stay with the insurer?

The money can be withdrawn immediately by writing a check for the full amount, or left in the account for as long as the beneficiary wants. The death benefit (but not the credited interest) is income-tax exempt; however, tax considerations might affect when the beneficiary might most advantageously withdraw the money.

Don’t insurers earn a higher rate on their investments than they credit on these accounts? If so, why don’t they credit the higher rate to beneficiaries?

Insurers generally do earn a higher rate on their investments than they pay on these accounts, but still pay an interest rate that compares favorably with other accounts of similar instant liquidity. The insurer also bears all the investment risk and provides a guaranteed positive rate of return irrespective of market conditions. In other words, even if the insurer were to lose money on its investments, the owner of the retained asset account would still earn interest. Some of the “spread” between the rate earned by the insurer and that paid on the retained asset account is used to cover the expense of providing this account. In some cases the difference between the insurer’s overall rate and the credited rate is small, because some insurers credit interest based on prevailing rates at the time the death occurred (which might be considerably higher than rates prevailing today).

This sounds like an attractive account. Once it’s created, can I add money to it?

The only money that can be added is money that comes from another life insurance death benefit from the same insurance company. This is not a deposit account like those provided by a bank or money market mutual fund.

Get all the information about group health insurance plans by sending your questions in the comment section.

Posted in Insurance

What is burial insurance?

“Burial insurance” usually refers to a whole life insurance policy with a death benefit of from $5,000 to $25,000. As its nickname implies, people buy this type of policy to provide money for funeral and burial costs for themselves and/or family members. It is possible to buy a policy after answering a few health-related questions on the application and with no medical exam.

Premiums are payable weekly or monthly. The premium is usually collected at the policyowner’s home or workplace, and the premium is usually a small round number, such as $2 or $3 per week; the death benefit is whatever that premium will buy given the insured’s current age. For example, a $3 per week premium might buy a $6,000 death benefit for a 36-year-old man or an $18,000 death benefit for a 9-year-old boy.

Burial policies may be designed to cover one person or everyone in a family.

Under some state laws, funeral homes may be licensed to sell burial insurance, but it is mainly sold through brokers and agents of insurance companies licensed to sell life insurance.

An approach that is similar to burial life insurance (and sometimes called burial or “pre-need” insurance) is pre-payment of your funeral arrangements. Under this program, you may select the funeral home, type of service, casket (or cremation), flowers, headstone, burial plot, the cost of digging and filling the grave, and other items, and lock in the prices for them by paying in advance.

Explore health insurance for small business owners and get the best plans for your employees, if you want to know more details then please send your queries in the comment section.

Posted in Medicare

What are the parts of Medicare? ABCD’s Explained.

When I first started my career in the Medicare world, I was overwhelmed with all the new information I had to learn. I found that breaking it down into bite-sized pieces made it easier to understand. It took a lot of time (and patience), and one of the hardest parts was understanding all the different parts of Medicare. Here are some tips that helped me understand Medicare.

What is Medicare?

Medicare is a federal health insurance program for people 65 and older, people under 65 with certain disabilities and people of all ages with end-stage renal disease. Medicare is partly funded by payroll taxes from most employers, employees and all people who are self-employed. The Medicare program offers basic coverage to help pay for things like doctor visits, hospital stays and surgeries.

What are the parts of Medicare?

Medicare is broken out into four parts. 

  1. Medicare Part A
  2. Medicare Part B
  3. Medicare Part C
  4. Medicare Part D

Medicare Parts A and B

Parts A and B are known as Original Medicare. This is the most basic coverage you can get.

Medicare Parts C and D

Parts C and D are available through private health plans. They’re both ways to enhance your health care coverage if you want more than what Original Medicare offers.

Medicare Parts A, B, C and D explained:

  • Part A (hospital coverage): Covers things like inpatient hospital stays, home health care and skilled nursing facility care.
  • Part B (medical coverage): Covers things like doctor visits, outpatient services and diagnostic screenings.
  • Part C (Medicare Advantage):  Medicare Advantage plans are offered through private health insurance companies. When you join a Medicare Advantage plan, you still have Medicare. The difference is the plan covers and pays for your services instead of Original Medicare. These plans must provide the same coverage as Original Medicare (so you’re not missing out on anything) and can also offer extra benefits.
  • Part D (prescription drug coverage): Only offered through private health plans.

When can I get Medicare?

You’re eligible for Medicare when you turn 65. There are a few different times you can enroll throughout the year. These are known as enrollment periods.

Explore blue cross medicare advantage plans and get the best options for your loved ones to choose from. if you want to know more details then please share comments in the comment section

Posted in Uncategorized

3 Keys to Bridging Gaps in Value-Based Care

As the industry continues to experiment with value-based care to pivot away from fee-for-service, specialty physicians can and should play a larger role in health insurance providers’ value-based care efforts.

There are major savings to be had in specialty care, which accounts for about 70% of health care spend.

While primary care physicians are traditionally seen as chronic care managers, specialists manage the most serious chronic diseases, attempting to halt their progression and control their complications.

Despite this, most accountable care organizations, shared savings programs, and intensive medical homes focus incentives on primary care doctors. Specialists can excel in new value-based payment models when 3 main criteria are met.

1. The right chronic illness

Some specialists are better equipped to move successfully into value-based care because of the types of patients they see.

Gastroenterologists, for example, care for patients with Inflammatory Bowel Disease, which includes Crohn’s disease and ulcerative colitis (UC).

Crohn’s and UC are high-beta conditions, which are symptomatic, chronic conditions that can rapidly deteriorate without patients realizing it, leading to serious complications that can drive emergency room visits, hospitalizations, and unwanted surgeries. As a result, they have highly variable per capita costs and are often treated with high-cost therapies..

These patients can benefit from high-touch care from their doctors.

2. The right data

Patients with conditions like Crohn’s often don’t realize their symptoms are worsening, so they don’t alert their care team.

To jump that hurdle and succeed in value-based care, clinicians need access to regularly reported data from those patients. In a pilot research partnership performed by  gastroenterologists at the Illinois Gastroenterology Group (IGG) in 2013, they asked 50 patients to respond to a short monthly survey of their symptoms. From there, nurses calculated a score related to patients’ symptom severity.

If a patient’s score signified a potential deterioration in their clinical status, nurses would reach out and schedule an appointment before things got worse.

During the year-long pilot, only 1 of the 50 patients was hospitalized, and no one required surgery. Based on the successof the pilot, Blue Cross and Blue Shield of Illinois designated IGG as its first specialty-based Intensive Medical Home. This initiative now involves practices across the state of Illinois, all using the SonarMD program.

A larger-scale study using propensity matched comparison against a control group in 2017 demonstrated use of SonarMD’s care coordination solution resulted in a statistically significant decline in hospitalizations, which reduced medical cost for each person by $6,500.

3. The right support

Having medical staff monitor the patient-reported data and create scores for every patient isn’t scalable. Specialty practices need the right full-time support to manage patients successfully and remain profitable.

External care coordinators can monitor the scores and then proactively connect patients with their physicians if there’s a potential need for intervention, taking the burden off specialty practices.

Specialty providers and health insurance providers can collaborate and align incentives through value-based contracting to improve patient/member outcomes and quality of life.

When the formula is met, involving specialists in value-based care arrangements truly achieves the quadruple aim of improved patient experience, better health of the overall population, lower costs, and happier providers: Patients feel more connected to their doctors, costs are lower, and physicians are more satisfied. If you want to know more about the group health plan then please send your queries by dropping a comment below.

Posted in Insurance

Medicare Part D: The What’s and How’s

As a Medicare Beneficiary you have a slew of decisions to make. One of the most important ones is selecting a Prescription Drug Plan. To some beneficiaries, this is not a priority if they are not currently taking any prescription medications. While this may be the case now, no one can guarantee this to be true for the future, because let’s face it, anyone can experience a health shift. To avoid making this decision now could be costly for you in the future. By choosing to protect yourself now, you are saving yourself money and headaches down the road, while ensuring you have access to the prescription medications you may need.

Medicare approved prescription drug plans, also called Medicare Part D, are plans offered by private health insurance companies. If you do not get this coverage when you first become eligible, you will most likely have to pay a late enrollment penalty. All plans have to conform to state and local insurance rules, but they are different because of the types of drugs covered and the amount of coverage. To give you even more choices, some insurers even offer tiered plans with different levels of coverage.

How to Get Medicare Prescription Drug Coverage?

There are two ways to get Medicare prescription Part D plans:

  • Stand-alone: On their own, Part D Plans, sometimes called PDPs, add prescription drug coverage to Original Medicare. People who have Original Medicare, a Medigap policy, or a Medicare Advantage plan without drug coverage might purchase a PDP.
  • With Blue Cross Medicare Advantage: Some Medicare Advantage (MA) plans, usually HMOs and PPOs, package Part D prescription drug coverage with health insurance. If your MA plan includes drug coverage, you do not need to buy a separate prescription policy. In fact, if you do sign up for a Part D plan, and your Part C (MA) plan already has prescription coverage, you could get disenrolled and returned to Original Medicare.

Which Drugs Are Covered?

Typically, insurers encourage their members to get generic drugs whenever possible. With some newer drugs, that is not possible, and brand names are still covered, but they are usually not 100 percent covered. In any case, each plan or insurer has something called a formulary. A Formulary is a list of specific generic and brand name drugs that the plan covers. All plans must carry at least two drugs in the same class UNLESS only one is available. 

How much does Medicare Part D cost?

Each plan has a monthly premium, and you may have this deducted from your social security in the same way that your Part B premium gets deducted. If you join an MA plan that already includes prescriptions, you just pay the additional premium (if any) for your MA plan. Typically, prescription policies with higher coverage levels may have higher premiums. We can help you compare prices, plans, and covered drugs at any time.

For many Medicare recipients the cost of their medications is more important than the Part D premium.

The cost of prescription medication will depend upon two things:

  • The medication that you need
  • The plan you select

Posted in Uncategorized

What is Medicare Assignment? How Does it work?

When you are covered by Medicare, it is important that you know whether or not your doctor accepts Medicare assignment. Assignment means that your doctor, provider or supplier agrees, or is required by law, to accept the Medicare approved amount as full payment for covered services. In most instances, providers and suppliers will accept Medicare assignment, however, it is always a good idea to ensure they do prior to moving forward with their services.

How does Medicare Assignment work?

For every procedure and service that is covered by Medicare, there is a Medicare approved price. Also known as Medicare Allowable Charges, the price is the total amount that Medicare will cover. Each doctor who accepts Medicare has the option to choose whether or not they want to accept Medicare’s allowable charges or not. Those that do accept Medicare “assignment.”

It’s the Doctor’s Choice

The first choice a doctor has is whether or not to accept Medicare. If they accept Medicare, they have to decide whether or not they will accept Medicare’s allowable charges as full payment. If they choose to accept Medicare’s price, that means they accept Medicare assignment. Accepting assignment also means that the provider will bill Medicare on your behalf. However, if they do not accept Medicare assignment, they are allowed to charge a patient up to 15% more than Medicare’s allowable charges. That 15% is called excess charge. 

If you are wanting to avoid being charged an excess charge, you will want to make sure that you are seeing doctors who accepts Medicare assignment. When you are researching doctors you will want to keep in mind that just because they accept Medicare, it does not mean they accept Medicare assignment. Once you have verified that your provider accepts Medicare assignment, you will want to continue to check with them as you make subsequent appointments because doctors and suppliers can choose to no longer accept Medicare assignment at any time during the year. 

State Specific Medicare Rules for Excess Charges:

There are a few states that prohibit excess charges and require the doctors to accept Medicare’s approved price for each service and procedure. Those states are:

  • Connecticut
  • Massachusetts
  • Minnesota
  • New York
  • Ohio
  • Pennsylvania
  • Rhode Island
  • Vermont

If you want to know more about Blue Cross Medicare advantage plan and benefits, please just drop your comments in the comment section.