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]

Medicare also has an important role driving changes in the entire health care system. Because Medicare pays for a huge share of health care in every region of the country, it has a great deal of power to set delivery and payment policies. For example, Medicare promoted the adaptation of prospective payments based on DRG's, which prevents unscrupulous providers from setting their own exorbitant prices.[80] Meanwhile, the Patient Protection and Affordable Care Act has given Medicare the mandate to promote cost-containment throughout the health care system, for example, by promoting the creation of accountable care organizations or by replacing fee-for-service payments with bundled payments.[81]
"I work primarily with adults on an individual, couple or family basis concerning relationship and mental health issues. Unless the focus is family therapy, I rarely see persons under 18. I am licensed as a clinical social worker(LCSW) and as a marriage and family therapist(LMFT)and a clinical member of the American Association for Marriage and Family Therapy(AAMFT). I have been in practice since 1980 in Morganton and have experience in in-patient and out-patient mental health, individual, marital therapy and developmental disabilities. I see older adults with life transition concerns."
"I assist adults seeking help with depression, anxiety, panic, stress, OCD, trauma, anger, relationship problems, career concerns, loss, meaning, mortality and other issues. Whether individual or couple, I tailor an approach specific to your need. Existential therapy is my foundation though I use an eclectic approach and draw upon various therapies. Therapy may be brief in duration or lengthy. It is sometimes uncomfortable - the "price" of honest introspection and change. I don't have your "answer" but will help you seek it. I strive - in the words of Irvin Yalom - to help "remove obstacles blocking the patient's path"."
As of 2016, 11 policies are currently sold—though few are available in all states, and some are not available at all in Massachusetts, Minnesota and Wisconsin. These plans are standardized with a base and a series of riders. These are Plan A, Plan B, Plan C, Plan D, Plan F, High Deductible Plan F, Plan G, Plan K, Plan L, Plan M, and Plan N. Cost is usually the only difference between Medigap policies with the same letter sold by different insurance companies in the same state. Unlike public Part C Medicare health Plans, Medigap plans have no networks, and any provider who accepts Original Medicare must also accept Medigap.
Basic Plan helps cover Medicare's Parts A and B coinsurance, hospice care coinsurance or copayment, skilled nursing facility care coinsurance, the first 3 pints of blood each year, and Wisconsin Mandated Benefits when not covered by Medicare. Basic Plan with Copay covers the same benefits as Basic Plan for Medicare Part A. For Medicare Part B medical expenses, the plan pays generally 20%, other than up to $20 per office visit and up to $50 per emergency room visit. The copayment of up to $50 is waived if you are admitted to any hospital and the emergency visit is covered as a Medicare Part A expense. This plan also covers the Wisconsin Mandated Benefits when not covered by Medicare.
Are you about to qualify for Original Medicare or having problems with your current Medicare insurance? The Annual Election period for enrolling in a new Medicare plan will be here soon. Minnesota Advantage plans in Minnesota, also known as Part C plans, can offer you a way to control costs and get access to local medical providers. In most cases, they also include Medicare Part D, so you don’t have to enroll in other prescription drug plans.
Each Medicare Supplement insurance plan offers a different level of basic benefits, but each lettered plan must include the same standardized basic benefits regardless of insurance company and location. For example, Medicare Supplement Plan G in Florida includes the same basic benefits as Plan G in North Dakota. Please note that if you live in Massachusetts, Minnesota, or Wisconsin, your Medicare Supplement insurance plan options are different than in the rest of the country. Medicare Supplement insurance plans do not have to cover vision, dental, long-term care, or hearing aids, but all plans must cover at least a portion of the following basic benefits:
Even if your prescriptions are covered, there may be hurdles to accessing them, so check the plan's rules. Starting in 2019, Medicare Advantage plans are allowed to require "step therapy," which means, in certain cases, you’ll need to try a less expensive drug before you'll be covered for a more expensive one. Or you may be steered toward a preferred pharmacy instead of your local drugstore.

We are not an insurance agency and are not affiliated with any plan. We connect individuals with insurance providers and other affiliates (collectively, “partners”) to give you, the consumer, an opportunity to get information about insurance and connect with agents. By completing the quotes form or calling the number listed above, you will be directed to a partner that can connect you to an appropriate insurance agent who can answer your questions and discuss plan options.

Medigap plans supplement your Original Medicare benefits, which is why these policies are also called Medicare Supplement plans. You’ll need to be enrolled in Original Medicare to be eligible for Medigap coverage, and you’ll need to stay enrolled in Original Medicare for your hospital and medical coverage. Medicare Supplement plans aren’t meant to provide stand-alone benefits.
Enrollment in public Part C health plans, including Medicare Advantage plans, grew from about 1% of total Medicare enrollment in 1997 when the law was passed (the 1% representing people on pre-law demonstration programs) to about 36% in 2018. Of course the absolute number of beneficiaries on Part C has increased even more dramatically on a percentage basis because of the large increase of people on Original Medicare since 1997. Almost all Medicare beneficiaries have access to at least two public Medicare Part C plans; most have access to three or more.
If you have Original Medicare and a Medicare Supplement plan, Original Medicare will pay first, and your Medigap policy will fill in the cost gaps. For example, suppose you have a $5,000 ambulance bill, and you have already met the yearly Medicare Part B deductible. Medicare Part B will pay 80% of your ambulance bill. If you have a Medicare Supplement plan that covers Part B copayments and coinsurance costs, then your Medigap policy would then pay the remaining 20% coinsurance of your $5,000 ambulance bill. Some Medicare Supplement plans may also cover the Part B deductible.
Original "fee-for-service" Medicare Parts A and B have a standard benefit package that covers medically necessary care as described in the sections above that members can receive from nearly any hospital or doctor in the country (if that doctor or hospital accepts Medicare). Original Medicare beneficiaries who choose to enroll in a Part C Medicare Advantage or other Part C health plan instead give up none of their rights as an Original Medicare beneficiary, receive the same standard benefits—as a minimum—as provided in Original Medicare, and get an annual out of pocket (OOP) upper spending limit not included in Original Medicare. However they must typically use only a select network of providers except in emergencies or for urgent care while travelling, typically restricted to the area surrounding their legal residence (which can vary from tens to over 100 miles depending on county). Most Part C plans are traditional health maintenance organizations (HMOs) that require the patient to have a primary care physician, though others are preferred provider organizations (which typically means the provider restrictions are not as confining as with an HMO). Others are hybrids of HMO and PPO called HMO-POS (for point of service) and a few public Part C health plans are actually fee for service hybrids. 

Products and services are provided exclusively by our partners, but not all offer the same plans or options. Possible options that may be offered include, but are not limited to, ACA-Qualified Plans, Medicare Plans, Short Term Plans, Christian/Health Sharing Plans, and Fixed Indemnity Plans. Descriptions are for informational purposes only and subject to change. We encourage you to shop around and explore all of your options. We are not affiliated with or endorsed by any government entity or agency.
You can get a Medicare Supplement insurance plan only if you already have Original Medicare. Medigap may help pay for out-of-pocket costs under Medicare Part A (hospital insurance) and Medicare Part B (medical insurance), but it does not include benefits for Medicare Part C (Medicare Advantage plans), Medicare Part D (Prescription Drug Plans), or any other private health insurance, Medicaid, Veterans’ Administration benefits, or TRICARE.

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.

"Welcome. You might be looking for a guide through troubled waters for yourself or someone you care about. I enjoy working with people who desire to live authentic lives and grow to their full potential. I can improve understanding of your symptoms, but each of us are unique individuals with differences in responses, I treat people, not diagnosis. I enjoy working with professionals and couples. I see everyone as a work in progress. I consider therapy a journey we take together that is rich in meaning and fulfillment. We are body, mind and spirit and I use a wholeness approach."

Medicare2019.com is a privately owned website and is not associated, endorsed or authorized by the Center for Medicare and Medicaid Services or any other government entity. This site contains basic information about Medicare, services related to Medicare, private medicare, Medigap and services for people with Medicare. If you would like to find more information about the Government Medicare program please visit the Official US Government Site: at www.medicare.gov
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.
"I enjoy working with and supporting individuals who are curious and motivated to move through the "stuck places" we all find ourselves in from time to time. I believe that our bodies have an inherent wisdom that, when listened to through mindfulness, will help direct and focus the therapy. While I specialize in treating childhood trauma, I also work with individuals dealing with anxiety, depression, relationship/personal growth challenges, as well as people struggling with illness and physical pain. I find great joy in walking with people on their journeys towards a more authentic, vibrant self...your own "True North"!"
It is important to understand your Medicare coverage choices and to pick your coverage carefully. How you choose to get your benefits and who you get them from can affect your out-of-pocket costs and where you can get your care. For instance, in Original Medicare, you are covered to go to nearly all doctors and hospitals in the country. On the other hand, Medicare Advantage Plans typically have network restrictions, meaning that you will likely be more limited in your choice of doctors and hospitals. However, Medicare Advantage Plans can also provide additional benefits that Original Medicare does not cover, such as routine vision or dental care.
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]
Massachusetts, Minnesota, and Wisconsin standardize their Medicare Supplement insurance plans differently from the rest of the country. In all states, insurance companies that sell Medicare Supplement insurance aren’t required to offer all plan types. However, any insurance company that sells Medigap insurance is required by law to offer Medigap Plan A. If an insurance company wants to offer other Medigap plans, it must sell either Plan C or Plan F in addition to any other plans it would like to sell.
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
Medigap plans may cover costs like Medicare coinsurance and copayments, deductibles, and emergency medical care while traveling outside of the United States. There are 10 standardized plan types in 47 states, each given a lettered designation (Plan G, for example). Plans of the same letter offer the same benefits regardless of where you purchase your plan. Massachusetts, Minnesota, and Wisconsin offer their own standardized Medigap plans.
Price transparency: To get a quote you can either call a United Medicare Advisors representative or complete an online form with your contact and health details. Upon sending it off, an agent will contact you with suggested plans. United Medicare Advisors need personal information to form a tailored quote for each individual. Their website says they save consumers an average of around $634 per year by switching to a new Medigap plan.
If you’re eligible at age 65, your initial enrollment period begins three months before your 65th birthday, includes the month you turn age 65, and ends three months after that birthday. However, if you don’t enroll in Medicare Part B during your initial enrollment period, you have another chance each year to sign up during a “general enrollment period” from January 1 through March 31. Your coverage begins on July 1 of the year you enroll. Read our Medicare publication for more information.
Generally, the different parts of Medicare help cover specific services. Most beneficiaries choose to receive their Parts A and B benefits through Original Medicare, the traditional fee-for-service program offered directly through the federal government. It is sometimes called Traditional Medicare or Fee-for-Service (FFS) Medicare. Under Original Medicare, the government pays directly for the health care services you receive. You can see any doctor and hospital that takes Medicare (and most do) anywhere in the country.

These Medigap insurance policies are standardized by CMS, but are sold and administered by private companies. Some Medigap policies sold before 2006 may include coverage for prescription drugs. Medigap policies sold after the introduction of Medicare Part D on January 1, 2006 are prohibited from covering drugs. Medicare regulations prohibit a Medicare beneficiary from being sold both a public Part C Medicare health plan and a private Medigap Policy. As with public Part C health plans, private Medigap policies are only available to beneficiaries who are already signed up for Original Medicare Part A and Part B. These policies are regulated by state insurance departments rather than the federal government although CMS outlines what the various Medigap plans must cover at a minimum. Therefore, the types and prices of Medigap policies vary widely from state to state and the degree of underwriting, discounts for new members, open enrollment and guaranteed issue also varies widely from state to state.
However, you may have to wait up to six months for coverage if you have a pre-existing health condition. The insurer through which you buy your Medigap policy can refuse to cover out-of-pocket costs for pre-existing conditions during that period. After six months, the Medigap policy must cover the pre-existing condition. The exception to this rule is if you buy a Medigap policy during your open enrollment period and have had continuous "creditable coverage," or a health insurance policy for the six months before buying a policy. The Medigap insurance company cannot withhold coverage for a pre-existing condition in that case.
Keep in mind that Medigap plans don’t include prescription drug coverage (Part D), so if you want help with your medication costs, you’ll need to enroll in a stand-alone Medicare Prescription Drug Plan. In addition, you can’t use your Medicare Supplement plan to pay for costs you may have with a Medicare Advantage plan. Medigap insurance can only be used to cover costs in Original Medicare.

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.


Basic Plan helps cover Medicare's Parts A and B coinsurance, hospice care coinsurance or copayment, skilled nursing facility care coinsurance, the first 3 pints of blood each year, and Wisconsin Mandated Benefits when not covered by Medicare. Basic Plan with Copay covers the same benefits as Basic Plan for Medicare Part A. For Medicare Part B medical expenses, the plan pays generally 20%, other than up to $20 per office visit and up to $50 per emergency room visit. The copayment of up to $50 is waived if you are admitted to any hospital and the emergency visit is covered as a Medicare Part A expense. This plan also covers the Wisconsin Mandated Benefits when not covered by Medicare.
This website and its contents are for informational purposes only. Nothing on the website should ever be used as a substitute for professional medical advice. You should always consult with your medical provider regarding diagnosis or treatment for a health condition, including decisions about the correct medication for your condition, as well as prior to undertaking any specific exercise or dietary routine.
Generally, the different parts of Medicare help cover specific services. Most beneficiaries choose to receive their Parts A and B benefits through Original Medicare, the traditional fee-for-service program offered directly through the federal government. It is sometimes called Traditional Medicare or Fee-for-Service (FFS) Medicare. Under Original Medicare, the government pays directly for the health care services you receive. You can see any doctor and hospital that takes Medicare (and most do) anywhere in the country.
As the name suggests, a Medicare Supplement insurance plan in California works as an add-on to Medicare Parts A and B coverage. It is not a stand-alone plan. Beneficiaries that want to switch from Medicare Parts A and B need to consider a Medicare Advantage plan rather than a Medicare Supplement. A Medicare Advantage plan is an alternative for Medicare Parts A and B, providing all the same coverage with additional benefits occasionally included.
Price transparency: To get a quote you can either call a United Medicare Advisors representative or complete an online form with your contact and health details. Upon sending it off, an agent will contact you with suggested plans. United Medicare Advisors need personal information to form a tailored quote for each individual. Their website says they save consumers an average of around $634 per year by switching to a new Medigap plan.

With the passage of the Balanced Budget Act of 1997, Medicare beneficiaries were formally given the option to receive their Original Medicare benefits through capitated health insurance Part C health plans, instead of through the Original fee for service Medicare payment system. Many had previously had that option via a series of demonstration projects that dated back to the early 1970s. These Part C plans were initially known in 1997 as "Medicare+Choice". As of the Medicare Modernization Act of 2003, most "Medicare+Choice" plans were re-branded as "Medicare Advantage" (MA) plans (though MA is a government term and might not even be "visible" to the Part C health plan beneficiary). Other plan types, such as 1876 Cost plans, are also available in limited areas of the country. Cost plans are not Medicare Advantage plans and are not capitated. Instead, beneficiaries keep their Original Medicare benefits while their sponsor administers their Part A and Part B benefits. The sponsor of a Part C plan could be an integrated health delivery system or spin-out, a union, a religious organization, an insurance company or other type of organization.

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.
Final decisions haven’t been made on exactly which counties in Minnesota will lose Cost plans next year, the government said. But based on current figures, insurance companies expect that Cost plans are going away in 66 counties across the state including those in the Twin Cities metro. They are expected to continue in 21 counties, carriers said, plus North Dakota, South Dakota and Wisconsin.
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.

We evaluated 10 well-known Medicare supplement insurance plans, and after careful review identified the eight best options for 2019. To draw our conclusions, we checked with customers in the market, reviewed data and consulted insurance experts. In summary, no one plan is best for all situations, so we recommend shopping around using a Medicare expert like United Medicare Advisors to compare plans. The eight Medicare supplement insurance companies we think are worth your consideration include: United Medicare Advisors, Cigna, Mutual of Omaha, Medicare.net, Humana, Blue Cross Blue Shield, Aetna and AARP by United Healthcare.
Of the Medicare beneficiaries who are not dual eligible for both Medicare (around 10% are fully dual eligible) and Medicaid or that do not receive group retirement insurance via a former employer (about 30%) or do not choose a public Part C Medicare health plan (about 35%) or who are not otherwise insured (about 5% -- e.g., still working and receiving employer insurance, on VA, etc.), almost all the remaining elect to purchase a type of private supplemental indemnity insurance policy called a Medigap plan (about 20%), to help fill in the financial holes in Original Medicare (Part A and B) in addition to public Part D. Note that the percentages add up to over 100% because many beneficiaries have more than one type of additional protection on top of Original Medicare.
This measure involves only Part A. The trust fund is considered insolvent when available revenue plus any existing balances will not cover 100 percent of annual projected costs. According to the latest estimate by the Medicare trustees (2018), the trust fund is expected to become insolvent in 8 years (2026), at which time available revenue will cover around 85 percent of annual projected costs for Part A services.[88] Since Medicare began, this solvency projection has ranged from two to 28 years, with an average of 11.3 years.[89] This and other projections in Medicare Trustees reports are based on what its actuaries call intermediate scenario but the reports also include worst-case and best case scenarios that are quite different (other scenarios presume Congress will change present law).
The Chief Actuary of the CMS must provide accounting information and cost-projections to the Medicare Board of Trustees to assist them in assessing the program's financial health. The Board is required by law to issue annual reports on the financial status of the Medicare Trust Funds, and those reports are required to contain a statement of actuarial opinion by the Chief Actuary.[13][14]
For institutional care, such as hospital and nursing home care, Medicare uses prospective payment systems. In a prospective payment system, the health care institution receives a set amount of money for each episode of care provided to a patient, regardless of the actual amount of care. The actual allotment of funds is based on a list of diagnosis-related groups (DRG). The actual amount depends on the primary diagnosis that is actually made at the hospital. There are some issues surrounding Medicare's use of DRGs because if the patient uses less care, the hospital gets to keep the remainder. This, in theory, should balance the costs for the hospital. However, if the patient uses more care, then the hospital has to cover its own losses. This results in the issue of "upcoding," when a physician makes a more severe diagnosis to hedge against accidental costs.[55]

Special Needs Plans (SNP): Special Needs Plans are for beneficiaries with certain unique situations and meet certain eligibility criteria. These plans may limit membership to people who have certain chronic conditions, live in an institution (such as a nursing home), or are dual eligibles (receive both Medicare and Medicaid benefits). You must meet the eligibility requirements of the Special Needs Plan to enroll; for example, to enroll in a Dual-Eligible Special Needs Plan in your service area, you must have both Medicare and Medicaid coverage.

We are not an insurance agency and are not affiliated with any plan. We connect individuals with insurance providers and other affiliates (collectively, “partners”) to give you, the consumer, an opportunity to get information about insurance and connect with agents. By completing the quotes form or calling the number listed above, you will be directed to a partner that can connect you to an appropriate insurance agent who can answer your questions and discuss plan options.
Blue Cross plans on sending letters in early July notifying about 200,000 subscribers who stand to lose their Medicare Cost plans. Minnetonka-based Medica, which started sending letters last week, expects that about 66,000 members will need to select a new plan. Officials with Bloomington-based HealthPartners say the insurer sent letters to about 34,000 enrollees this month explaining the change.

As a Medicare beneficiary, you may also be enrolled in other types of coverage, either through the Medicare program or other sources, such as an employer. When you first sign up for Original Medicare, you’ll fill out a form called the Initial Enrollment Questionnaire and be asked whether you have other types of insurance. It’s important to include all other types of coverage you have in this questionnaire. Medicare uses this information when deciding who pays first when you receive health-care services.
**NY: In New York, the Excess Charge is limited to 5%; PA and OH: 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.
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