As a Medicare recipient, you have choices for your healthcare. If you still have job-related health insurance, for instance, you may not need to enhance your Medicare benefits and can delay enrollment in either Medicare Advantage Plans or Minnesota Medigap plans. If not, you should know that Part A and Part B of Medicare include many deductibles and copays.
A: Original Medicare, also known as traditional Medicare, includes Part A and Part B. It allows beneficiaries to go to any doctor or hospital that accepts Medicare, anywhere in the United States. Medicare will pay its share of the charge for each service it covers. You pay the rest, unless you have additional insurance that covers those costs. Original Medicare provides many health care services and supplies, but it doesn’t pay all your expenses. — Read Full Answer
A Medicare Advantage Health Plan (Medicare Part C) may provide more help at a lower cost than traditional Medicare plus Medigap. Instead of paying for Parts A, B, and D, a person would enroll through a private insurance company that, in many cases, covers everything provided by Parts A, B, and D and may offer additional services. The beneficiary would pay the Medicare Advantage premium along with the Part B premium in most cases.

The PPACA instituted a number of measures to control Medicare fraud and abuse, such as longer oversight periods, provider screenings, stronger standards for certain providers, the creation of databases to share data between federal and state agencies, and stiffer penalties for violators. The law also created mechanisms, such as the Center for Medicare and Medicaid Innovation to fund experiments to identify new payment and delivery models that could conceivably be expanded to reduce the cost of health care while improving quality.[118]
Retirement of the Baby Boom generation is projected by 2030 to increase enrollment to more than 80 million. In addition the facts that the number of workers per enrollee will decline from 3.7 to 2.4 and that overall health care costs in the nation are rising pose substantial financial challenges to the program. Medicare spending is projected to increase from just over $740 billion in 2018 to just over $1.2 trillion by 2026, or from 3.7% of GDP to 4.7%.[19] Baby-boomers are projected to have longer life spans, which will add to the future Medicare spending. The 2019 Medicare Trustees Report estimates that spending as a percent of GDP will grow to 6% by 2043 (when the last of the baby boomers turns 80) and then flatten out to 6.5% if GDP by 2093. In response to these financial challenges, Congress made substantial cuts to future payouts to providers (primarily acute care hospitals and skilled nursing facilities) as part of PPACA in 2010 and the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and policymakers have offered many additional competing proposals to reduce Medicare costs further.
Senior supplements are supplemental health insurance plans designed specifically for senior’s needs. Supplemental health insurance includes products like dental, vision, and life insurance. These plans are sold by private health insurance companies and are not Medicare. They can be purchased at any time, though there are age restrictions to certain products (like life insurance).
"Raising kids can be difficult. Healthy marriages take work. Even the strongest individuals need help sometimes. The bulk of my experience is working with adolescents and families. During that time I have seen a broad range individuals and families who were experiencing both high and low points in their lives. This experience has taught me that none of us are immune to the stress of everyday life. I believe that healthy psychotherapy can assist us in finding our own solutions to our own problems- whether those problems are internal or external, personal or relational, and individual or family oriented."

A Medicare Supplement insurance plan in California will not provide coverage for services like vision and hearing care. Dental coverage is also not included with these plans. Prescription drug benefits are not included in Medicare Supplement insurance plans. Beneficiaries looking for prescription drug coverage should consider enrolling in either a Medicare Advantage plan with prescription drug benefits or a Medicare Part D prescription drug plan.
More limited income-relation of premiums only raises limited revenue. Currently, only 5 percent of Medicare enrollees pay an income-related premium, and most only pay 35 percent of their total premium, compared to the 25 percent most people pay. Only a negligible number of enrollees fall into the higher income brackets required to bear a more substantial share of their costs—roughly half a percent of individuals and less than three percent of married couples currently pay more than 35 percent of their total Part B costs.[149]
More limited income-relation of premiums only raises limited revenue. Currently, only 5 percent of Medicare enrollees pay an income-related premium, and most only pay 35 percent of their total premium, compared to the 25 percent most people pay. Only a negligible number of enrollees fall into the higher income brackets required to bear a more substantial share of their costs—roughly half a percent of individuals and less than three percent of married couples currently pay more than 35 percent of their total Part B costs.[149]
For doctors and medical procedures (Part B) at the hospital and at home: The patient would pay 20 percent of all costs after meeting the $185 deductible. Unlike many other health insurance policies, there is no cap or maximum out-of-pocket amount on what a person could owe. The American Heart Association says that the minimum cost of bypass heart surgery is $85,891, in which case, the Part B copay would be over $17,000.
*AARP endorses the AARP® Medicare Supplement Insurance Plans, insured by UnitedHealthcare Insurance Company. UnitedHealthcare Insurance Company pays royalty fees to AARP for the use of its intellectual property. These fees are used for the general purposes of AARP. AARP and its affiliates are not insurers. AARP does not employ or endorse agents, brokers or producers.
In the states that chose to expand their coverage once the Affordable Care Act became effective, more adults and families on low incomes became eligible because the new provision allowed enrolment at up to 138 percent of the FPL. In return, the federal government covers all of the expansion costs for the first 3 years and over 90 percent of the costs moving forward.
Beneficiaries may enroll in a Medicare Supplement insurance plan in California during their six-month Medigap Open Enrollment Period, beginning on the first day of the month that they are 65 or older and enrolled in Medicare Part B. During this time, beneficiaries aren’t subject to medical underwriting, which means they cannot be charged higher premiums or denied coverage based solely on medical history or a current medical condition. However, if a beneficiary adds or changes a Medicare Supplement insurance plan at any other time, medical underwriting guidelines will generally apply. 

Under the 2003 law that created Medicare Part D, the Social Security Administration offers an Extra Help program to lower-income seniors such that they have almost no drug costs; in addition approximately 25 states offer additional assistance on top of Part D. It should be noted again for beneficiaries who are dual-eligible (Medicare and Medicaid eligible) Medicaid may pay for drugs not covered by Part D of Medicare. Most of this aid to lower-income seniors was available to them through other programs before Part D was implemented.
Medicare supplement plans are related to Medicare. Like Medicare’s “Parts”, each plan letter offers different benefits and has a different premium amount. They are designed to fill the “coverage gaps” in Original Medicare benefits (hence the name Medigap). These products will cover healthcare expenses otherwise left out of Original Medicare coverage, like coinsurance and deductibles. However, Medigap plans do not include dental, vision, or any other supplemental health insurance benefits.

Robert M. Ball, a former commissioner of Social Security under President Kennedy in 1961 (and later under Johnson, and Nixon) defined the major obstacle to financing health insurance for the elderly: the high cost of care for the aged combined with the generally low incomes of retired people. Because retired older people use much more medical care than younger employed people, an insurance premium related to the risk for older people needed to be high, but if the high premium had to be paid after retirement, when incomes are low, it was an almost impossible burden for the average person. The only feasible approach, he said, was to finance health insurance in the same way as cash benefits for retirement, by contributions paid while at work, when the payments are least burdensome, with the protection furnished in retirement without further payment.[97] In the early 1960s relatively few of the elderly had health insurance, and what they had was usually inadequate. Insurers such as Blue Cross, which had originally applied the principle of community rating, faced competition from other commercial insurers that did not community rate, and so were forced to raise their rates for the elderly.[98]
The Patient Protection and Affordable Care Act ("PPACA") of 2010 made a number of changes to the Medicare program. Several provisions of the law were designed to reduce the cost of Medicare. The most substantial provisions slowed the growth rate of payments to hospitals and skilled nursing facilities under Parts A of Medicare, through a variety of methods (e.g., arbitrary percentage cuts, penalties for readmissions).
In 2018, Medicare provided health insurance for over 59.9 million individuals—more than 52 million people aged 65 and older and about 8 million younger people.[1] On average, Medicare covers about half of healthcare expenses of those enrolled. Despite often being called single-payer, United States Medicare is funded by a combination of a payroll tax, beneficiary premiums and surtaxes from beneficiaries, co-pays and deductibles, and general U.S. Treasury revenue. In addition, per the Medicare Trustees, almost everyone on Medicare adds private or public supplements to so-called Original Medicare, which have additional premiums and co-pays. Instead of being single payer, some people on United States Medicare have as many as six payers including themselves.
Part D Total Premium: The Part D Total Premium is the sum of the Basic and Supplemental Premiums. Note: the Part D Total Premium is net of any Part A/B rebates applied to "buy down" the drug premium for Medicare Advantage; for some plans the total premium may be lower than the sum of the basic and supplemental premiums due to negative basic or supplemental premiums.
Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
As a Medicare recipient, you have choices for your healthcare. If you still have job-related health insurance, for instance, you may not need to enhance your Medicare benefits and can delay enrollment in either Medicare Advantage Plans or Minnesota Medigap plans. If not, you should know that Part A and Part B of Medicare include many deductibles and copays.
Medicare Advantage is a PPO plan with a Medicare contract. Enrollment in Medicare Advantage depends on contract renewal. Enrollment in the plan after December 31, 2018 cannot be guaranteed. Either CMS or the plan may choose not to renew the contract, or the plan may choose to change the area it serves. Any such change may result in termination of your enrollment. Benefits, premiums, copayments and/or coinsurance may change on January 1 of each year. The formulary, pharmacy network and/or provider network may change at any time. You will receive notice when necessary.

Basic Plan helps cover Medicare's Parts A and B coinsurance, hospice care coinsurance, skilled nursing facility coinsurance, Home Health Care Services, Medical Supplies, and foreign travel emergency care. Extended Basic Plan provides the same benefits listed for the Basic Plan, plus benefits for Medicare's Part A hospital deductible, Medicare's Part B deductible, non-Medicare eligible expenses, and preventive medical care when not paid by Medicare.
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.
In 1977, the Health Care Financing Administration (HCFA) was established as a federal agency responsible for the administration of Medicare and Medicaid. This would be renamed to Centers for Medicare and Medicaid Services (CMS) in 2001. By 1983, the diagnosis-related group (DRG) replaced pay for service reimbursements to hospitals for Medicare patients.
The 2003 payment formulas succeeded in increasing the percentage of rural and inner city poor that could take advantage of the OOP limit and lower co-pays and deductibles—as well as the coordinated medical care—associated with Part C plans. In practice however, one set of Medicare beneficiaries received more benefits than others. The MedPAC Congressional advisory group found in one year the comparative difference for "like beneficiaries" was as high as 14% and have tended to average about 2% higher.[47] The word "like" in the previous sentence is key. MedPAC does not include all beneficiaries in its comparisons and MedPAC will not define what it means by "like" but it apparently includes people who are only on Part A, which severely skews its percentage comparisons—see January 2017 MedPAC meeting presentations. The differences caused by the 2003-law payment formulas were almost completely eliminated by PPACA and have been almost totally phased out according to the 2018 MedPAC annual report, March 2018. One remaining special-payment-formula program—designed primarily for unions wishing to sponsor a Part C plan—is being phased out beginning in 2017. In 2013 and since, on average a Part C beneficiary cost the Medicare Trust Funds 2%-5% less than a beneficiary on traditional fee for service Medicare, completely reversing the situation in 2006-2009 right after implementation of the 2003 law and restoring the capitated fee vs fee for service funding balance to its original intended parity level.
A Medicare Supplement insurance plan in California will not provide coverage for services like vision and hearing care. Dental coverage is also not included with these plans. Prescription drug benefits are not included in Medicare Supplement insurance plans. Beneficiaries looking for prescription drug coverage should consider enrolling in either a Medicare Advantage plan with prescription drug benefits or a Medicare Part D prescription drug plan.
Part B coverage includes outpatient physician services, visiting nurse, and other services such as x-rays, laboratory and diagnostic tests, influenza and pneumonia vaccinations, blood transfusions, renal dialysis, outpatient hospital procedures, limited ambulance transportation, immunosuppressive drugs for organ transplant recipients, chemotherapy, hormonal treatments such as Lupron, and other outpatient medical treatments administered in a doctor's office. It also includes chiropractic care. Medication administration is covered under Part B if it is administered by the physician during an office visit.

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Individuals who join a Tufts Medicare Preferred Supplement plan may be eligible for a discounted premium. The discount is available to individuals 65 and older who join a Supplement plan within six (6) months of acquiring their Medicare Part B coverage for the first time. The discounted premium begins with your plan's initial effective date and applies as follows: 15% off your premium for months 1 through 12, 10% off your premium for months 13 through 24, and 5% off your premium for months 25 through 36. After month 36, the discount ends and the current premium rate will apply. This discount does not apply to the premium for the optional Tufts Health Plan dental add-on coverage or employer group membership.

Another wrinkle is that people who want a supplement might have a better chance of getting into the coverage during the transition out of their Medicare Cost plan, when the supplement is provided on a “guaranteed issue” basis. Later, insurance companies can ask questions about a senior’s health status and deny coverage depending on the answers, said Greiner of the Minnesota Board on Aging.
As an alternative to obtaining Original Medicare coverage directly from the government, you may want to consider Medicare Advantage (sometimes referred to as Medicare Part C) in Minnesota. Medicare Advantage plans are offered by private insurance companies that contract with CMS to provide all Original Medicare benefits except hospice care, which is paid by Medicare Part A. Many Medicare Advantage plans also include extra benefits such as routine dental and vision care.
* NY: In New York, the Excess Charge is limited to 5%; PA and OH: Note: Under Pennsylvania and Ohio law, a physician may not charge or collect fees from Medicare patients which exceed the Medicare-approved Part B charge. Plans F and G pay benefits for excess charges when services are rendered in a jurisdiction not having a balance billing law; TX: In Texas, the amount cannot exceed 15% over the Medicare- approved amount or any other charge limitation established by the Medicare program or state law. Note that the limiting charge applies only to certain services and does not apply to some supplies and durable medical equipment; VT: Vermont law generally prohibits a physician from charging more than the Medicare-approved amount. However, there are exceptions and this prohibition may not apply if you receive services out of state.
Medicare Part D went into effect on January 1, 2006. Anyone with Part A or B is eligible for Part D, which covers mostly self-administered drugs. It was made possible by the passage of the Medicare Modernization Act of 2003. To receive this benefit, a person with Medicare must enroll in a stand-alone Prescription Drug Plan (PDP) or public Part C healh plan with integrated prescription drug coverage (MA-PD). These plans are approved and regulated by the Medicare program, but are actually designed and administered by various sponsors including charities, integrated health delivery systems, unions and health insurance companies; almost all these sponsors in turn use pharmacy benefit managers in the same way as they are used by sponsors of health insurance for those not on Medicare. Unlike Original Medicare (Part A and B), Part D coverage is not standardized (though it is highly regulated by the Centers for Medicare and Medicaid Services). Plans choose which drugs they wish to cover (but must cover at least two drugs in 148 different categories and cover all or "substantially all" drugs in the following protected classes of drugs: anti-cancer; anti-psychotic; anti-convulsant, anti-depressants, immuno-suppressant, and HIV and AIDS drugs). The plans can also specify with CMS approval at what level (or tier) they wish to cover it, and are encouraged to use step therapy. Some drugs are excluded from coverage altogether and Part D plans that cover excluded drugs are not allowed to pass those costs on to Medicare, and plans are required to repay CMS if they are found to have billed Medicare in these cases.[48]
In 1977, the Health Care Financing Administration (HCFA) was established as a federal agency responsible for the administration of Medicare and Medicaid. This would be renamed to Centers for Medicare and Medicaid Services (CMS) in 2001. By 1983, the diagnosis-related group (DRG) replaced pay for service reimbursements to hospitals for Medicare patients.
No part of Medicare pays for all of a beneficiary's covered medical costs and many costs and services are not covered at all. The program contains premiums, deductibles and coinsurance, which the covered individual must pay out-of-pocket. A study published by the Kaiser Family Foundation in 2008 found the Fee-for-Service Medicare benefit package was less generous than either the typical large employer preferred provider organization plan or the Federal Employees Health Benefits Program Standard Option.[49] Some people may qualify to have other governmental programs (such as Medicaid) pay premiums and some or all of the costs associated with Medicare.
This absolutely varies by region. Since Medicare supplement insurance plans are standardized, you don’t have to worry about benefits being different. This means you’ll want to scout out the Medicare gap plans with the lowest rates in your area. The best supplemental insurance rates will be different in each state, and your age, gender, tobacco usage and eligibility for household discount also affect your rate.
"We all have obstacles in this life that we must navigate. The part that falls on us is how we cope with these obstacles. You have to make decisions that could hinder our growth. You may become overwhelmed and do nothing. But guess what, that is still a decision. My role is to help guide you to the path that is best for you. I offer different techniques that are shaped to help you obtain the answers that you are seeking. As a team we will develop coping skills, identify patterns and learn to make better decisions."
This absolutely varies by region. Since Medicare supplement insurance plans are standardized, you don’t have to worry about benefits being different. This means you’ll want to scout out the Medicare gap plans with the lowest rates in your area. The best supplemental insurance rates will be different in each state, and your age, gender, tobacco usage and eligibility for household discount also affect your rate.
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 controversy over who exactly should take responsibility for coordinating the care of the dual eligibles. There have been some proposals to transfer dual eligibles into existing Medicaid managed care plans, which are controlled by individual states.[143] But many states facing severe budget shortfalls might have some incentive to stint on necessary care or otherwise shift costs to enrollees and their families to capture some Medicaid savings. Medicare has more experience managing the care of older adults, and is already expanding coordinated care programs under the ACA,[144] though there are some questions about private Medicare plans' capacity to manage care and achieve meaningful cost savings.[145]

Over the long-term, Medicare faces significant financial challenges because of rising overall health care costs, increasing enrollment as the population ages, and a decreasing ratio of workers to enrollees. Total Medicare spending is projected to increase from $523 billion in 2010 to around $900 billion by 2020. From 2010 to 2030, Medicare enrollment is projected to increase dramatically, from 47 million to 79 million, and the ratio of workers to enrollees is expected to decrease from 3.7 to 2.4.[82] However, the ratio of workers to retirees has declined steadily for decades, and social insurance systems have remained sustainable due to rising worker productivity. There is some evidence that productivity gains will continue to offset demographic trends in the near future.[83]

"We all have obstacles in this life that we must navigate. The part that falls on us is how we cope with these obstacles. You have to make decisions that could hinder our growth. You may become overwhelmed and do nothing. But guess what, that is still a decision. My role is to help guide you to the path that is best for you. I offer different techniques that are shaped to help you obtain the answers that you are seeking. As a team we will develop coping skills, identify patterns and learn to make better decisions."
The expenditures from the trust funds under Parts A and B are fee for service whereas the expenditures from the trust funds under Parts C and D are capitated. In particular, it is important to understand that Medicare itself does not purchase either self- administered or professionally administered drugs. In Part D, the Part D Trust Fund helps beneficiaries purchase drug insurance. For Part B drugs, the trust funds reimburses the professional that administers the drugs and allows a mark up for that service. 

Your information and use of this site is governed by our updated Terms of Use and Privacy Policy. By entering your name and information above and clicking the Request a Call button, you are consenting to receive calls or emails regarding your Medicare Advantage, Medicare Supplement Insurance, and Prescription Drug Plan options (at any phone number or email address you provide) from an eHealth representative or one of our licensed insurance agent business partners, and you agree such calls may use an automatic telephone dialing system or an artificial or prerecorded voice to deliver messages even if you are on a government do-not-call registry. This agreement is not a condition of enrollment.
If you have special health care or financial needs, you may qualify for a Special Needs Plan. All Special Needs Plans include drug coverage. Other benefits may include coordination of care, transportation to and from medical appointments, credits to buy everyday health items, and routine vision and dental coverage. There are four main types of Special Needs Plans: 

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.[135] Some have questioned the ability of the federal government to achieve greater savings than the largest PDPs, since some of the larger plans have coverage pools comparable to Medicare's, though the evidence from the VHA is promising. Some also worry that controlling the prices of prescription drugs would reduce incentives for manufacturers to invest in R&D, though the same could be said of anything that would reduce costs.[133] However the comparisons with the VHA point out that the VA only covers about half the drugs as Part D.
Helpfulness: You can search the site for the closest available agent for a face-to-face talk, or fill out a quick online form stating specific times you’re available for a customer service representative to call you – as well as include any notes to explain your needs. The site also features an education section titled “Planning and Advice” which is essentially a Medicare 101 info center to turn you into a Medicare pro. The section includes helpful articles touching on topics including your enrollment period and eligibility rules. That way you can read up on an arsenal of info before you reach out to a representative so you have a better handle on what to ask and what you’re looking for.

Part A covers inpatient hospital stays where the beneficiary has been formally admitted to the hospital, including semi-private room, food, and tests. As of January 1, 2018, Medicare Part A had an inpatient hospital deductible of $1340, coinsurance per day as $335 after 61 days confinement within one "spell of illness", coinsurance for "lifetime reserve days" (essentially, days 91-150 of one or more stay of more than 60 days) of $670 per day. The structure of coinsurance in a Skilled Nursing Facility (following a medically necessary hospital confinement of 3 nights in row or more) is different: zero for days 1-20; $167.50 per day for days 21-100. Many medical services provided under Part A (e.g., some surgery in an acute care hospital, some physical therapy in a skilled nursing facility) is covered under Part B. These coverage amounts increase or decrease yearly on 1st day of the year.


This absolutely varies by region. Since Medicare supplement insurance plans are standardized, you don’t have to worry about benefits being different. This means you’ll want to scout out the Medicare gap plans with the lowest rates in your area. The best supplemental insurance rates will be different in each state, and your age, gender, tobacco usage and eligibility for household discount also affect your rate.
The Patient Protection and Affordable Care Act ("PPACA") of 2010 made a number of changes to the Medicare program. Several provisions of the law were designed to reduce the cost of Medicare. The most substantial provisions slowed the growth rate of payments to hospitals and skilled nursing facilities under Parts A of Medicare, through a variety of methods (e.g., arbitrary percentage cuts, penalties for readmissions).
This link is being made available so that you have an opportunity to obtain information from the third party on its website. It is provided as a convenience and not as an endorsement of the content of the third party site or any products or services offered on that site. We do not take responsibility for the products or services offered or the content on any linked site or any link contained in a linked site.
The Medicare Rights Center has an interactive tool that provides easy-to-use information about enrollment and plan options. And if you want state-specific details, the State Health Insurance Assistance Program (SHIP) can tell you more about offerings in your area. To find your state’s SHIP program, go to Shiptacenter.org or call 877-839-2675 to talk to a trained counselor.

The open enrollment period for Medicare runs from October 15 through December 7 on an annual basis, however, this is not the case for individuals interested in Medigap (Medicare Supplement) coverage. The open enrollment period for a Medigap policy is the six month period that starts the first day of the month that you turn 65 or older and enrolled in Part B. After this period, your ability to buy a Medigap policy may be limited and it may be more costly. Each state handles things differently, but there are additional open enrollment periods in some cases.
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