One of the Medicare Savings Programs (MSPs) is for Qualified Medicare Beneficiaries (QMB). The QMB program covers the premiums for Medicare Part A and Part B. The deductibles, copays, and coinsurance costs are covered as well. An individual can qualify for this program with an income of no more than $1,032 a month. A married couple can also qualify with a combined income of less than $1,392 a month.
On August 1, 2007, the US House United States Congress voted to reduce payments to Medicare Advantage providers in order to pay for expanded coverage of children's health under the SCHIP program. As of 2008, Medicare Advantage plans cost, on average, 13 percent more per person insured for like beneficiaries than direct payment plans.[111] Many health economists have concluded that payments to Medicare Advantage providers have been excessive. The Senate, after heavy lobbying from the insurance industry, declined to agree to the cuts in Medicare Advantage proposed by the House. President Bush subsequently vetoed the SCHIP extension.[112]
The Omnibus Budget Reconciliation Act of 1989 made several changes to physician payments under Medicare. Firstly, it introduced the Medicare Fee Schedule, which took effect in 1992. Secondly, it limited the amount Medicare non-providers could balance bill Medicare beneficiaries. Thirdly, it introduced the Medicare Volume Performance Standards (MVPS) as a way to control costs.[56]
As of January 1, 2016, Medicare's unfunded obligation over the 75 year timeframe is $3.8 trillion for the Part A Trust Fund and $28.6 trillion for Part B. Over an infinite timeframe the combined unfunded liability for both programs combined is over $50 trillion, with the difference primarily in the Part B estimate.[88][90] These estimates assume that CMS will pay full benefits as currently specified over those periods though that would be contrary to current United States law. In addition, as discussed throughout each annual Trustees' report, "the Medicare projections shown could be substantially understated as a result of other potentially unsustainable elements of current law." For example, current law effectively provides no raises for doctors after 2025; that is unlikely to happen. It is impossible for actuaries to estimate unfunded liability other than assuming current law is followed (except relative to benefits as noted), the Trustees state "that actual long-range present values for (Part A) expenditures and (Part B/D) expenditures and revenues could exceed the amounts estimated by a substantial margin."

"It takes courage to take the first step to participate in therapy. I begin my work with a focus on relationship building as the therapeutic relationship is essential to a successful therapy experience. I believe it is critical to view clients from a non-judgmental perspective, and recognize that each individual is capable of obtaining a meaningful life. I provide a safe space for clients to address the challenges that prevent them from living the life they desire. My role is to facilitate growth and meaning-making of those experiences that are most relevant to the clients I serve."
*Pre-existing conditions are generally health conditions that existed before the start of a policy. They may limit coverage, be excluded from coverage, or even prevent you from being approved for a policy; however, the exact definition and relevant limitations or exclusions of coverage will vary with each plan, so check a specific plan’s official plan documents to understand how that plan handles pre-existing conditions.
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.
Coverage can be difficult to understand, and varies by market. Massachusetts, Minnesota, and Wisconsin provide their own policies for residents. The remaining 47 states in the U.S. rely on 11 standard plans that accommodate all types of health, lifestyle, and budget demands. These plans vary based coinsurance needs such as hospital stay, hospice care, travel expectations and more.
Now that you know more about Medicare Supplement plans, you may be wondering if one of these plans may be right for you. I always enjoy helping people figure this out. If you’d like to start out by getting some more information in front of you, use the links below, which let you schedule a phone appointment or have me email you information about plans. To take a look at all available Medicare plans right now, use the Compare Plans buttons on this page. To get to know me better, take a look at my photo and profile below (see my profile by clicking on the “View profile” link).
Lots of people ask us about Medicare Plan F going away. Yes, in 2020, they will phase out Plan F. It will be no longer be available for new enrollees. Medicare beneficiaries who are already enrolled in it, though, will be able to keep it. Congress passed legislation that will no longer allow Medicare supplement policies to cover the Part B deductible for newly eligible Medicare beneficiaries on or after January 1, 2020.
If you have a Medicare Advantage plan, you’re still enrolled in the Medicare program; in fact, you must sign up for Medicare Part A and Part B to be eligible for a Medicare Advantage plan. The Medicare Advantage plan administers your benefits to you. Depending on the plan, Medicare Advantage can offer additional benefits beyond your Part A and Part B benefits, such as routine dental, vision, and hearing services, and even prescription drug coverage. 

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.
Since the Medicare program began, the CMS (that was not always the name of the responsible bureaucracy) has contracted with private insurance companies to operate as intermediaries between the government and medical providers to administer Part A and Part B benefits. Contracted processes include claims and payment processing, call center services, clinician enrollment, and fraud investigation. Beginning in 1997 and 2005, respectively, these Part A and B administrators (whose contracts are bid out periodically), along with other insurance companies and other companies or organizations (such as integrated health delivery systems, unions and pharmacies), also began administering Part C and Part D plans.
‡Advantage Plus is available for all Senior Advantage (HMO) and Medicare Advantage (HMO) individual plan members. Advantage Plus is available for all Medicare Plus (Cost) individual plan members, except for Basic plans. In California, Advantage Plus is not available under the Medicare Medi-Cal (HMO SNP) plan. In Colorado, Advantage Plus is not available under the Medicare Medicaid (HMO SNP) plan.

While the majority of providers accept Medicare assignments, (97 percent for some specialties),[64] and most physicians still accept at least some new Medicare patients, that number is in decline.[65] While 80% of physicians in the Texas Medical Association accepted new Medicare patients in 2000, only 60% were doing so by 2012.[66] A study published in 2012 concluded that the Centers for Medicare and Medicaid Services (CMS) relies on the recommendations of an American Medical Association advisory panel. The study led by Dr. Miriam J. Laugesen, of Columbia Mailman School of Public Health, and colleagues at UCLA and the University of Illinois, shows that for services provided between 1994 and 2010, CMS agreed with 87.4% of the recommendations of the committee, known as RUC or the Relative Value Update Committee.[67]
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.

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).
"Working as a licensed counselor for over 29 years has tenderized my heart towards those who want to get "unstuck" from patterns and places we all can find ourselves in. Though I specialize in trauma work and family systems, I work with clients who have anxiety issues, depression, abuse, addictions, sexual trauma, disturbing life events, self concept and life change adjustments. I love what I do and am passionate about walking with people through their pain, shame and fear to a place of hope."
"I strive to assist distressed individuals in regulating emotions, improving mood, cultivating positive thinking, changing unproductive behaviors, and in creating wellness, life satisfaction, and self-acceptance. By exploring and identifying unique, personal thinking patterns, challenges, needs, and strengths we work in therapy to promote the meaning in life, responsibility, and the pursuit of genuineness and the best in self, life and relationships. My approach is compassionate, backed by extensive training and I have over 30 years of experience in education, community service, and psychotherapy with children, students, adults, couples, families, and groups."
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.
Public Part C Medicare Advantage health plan members typically also pay a monthly premium in addition to the Medicare Part B premium to cover items not covered by traditional Medicare (Parts A & B), such as the OOP limit, self-administered prescription drugs, dental care, vision care, annual physicals, coverage outside the United States, and even gym or health club memberships as well as—and probably most importantly—reduce the 20% co-pays and high deductibles associated with Original Medicare.[46] But in some situations the benefits are more limited (but they can never be more limited than Original Medicare and must always include an OOP limit) and there is no premium. The OOP limit can be as low as $1500 and as high as but no higher than $6700. In some cases, the sponsor even rebates part or all of the Part B premium, though these types of Part C plans are becoming rare.
Preferred Provider Organization (PPO) plans: This type of Medicare Advantage plan offers more provider flexibility. PPOs typically have a preferred provider network, but you may also use out-of-network doctors if you choose, although your cost sharing may be higher. Unlike HMOs, you don’t need referrals for specialist care and you aren’t required to have a primary care doctor.
Depending on the state that you live in, you may not be able to get Medicare Supplement coverage if you’re under 65 and have Medicare because of disability, end-stage renal disease, or amyotrophic lateral sclerosis. States aren’t required to offer Medigap coverage to beneficiaries under 65. If you’re under 65 and enrolled in Original Medicare, check with your state’s insurance department to find out if you’re eligible to enroll in a Medicare Supplement plan.

In states with lots of rural areas, like Minnesota, Medicare Cost plans tend to be more popular because they offer more flexibility than an HMO. If a plan member gets services inside of the network of Medicare Cost Plans, they work the same way that an HMO works. If the plan member decides to visit a non-network medical provider, Medicare Cost Plans will cover those services the same way that Original Medicare Part A and Part B do. Typically, a Medicare Advantage HMO won’t cover non-emergency services outside of the network at all.
CMS projections in 2018 estimated that the average basic premium for a Medicare Part D prescription drug plan will fall to $32.50 per month this year from its $33.59 last year. But you need to look beyond the premiums to determine your total costs: Make a list of your prescription medications, then check out your plan’s formularies to make sure your drugs are covered and to learn which tier your drugs are in. (The higher the tier, the higher your copay.) And look at the costs of deductibles and coinsurance, especially if you’re taking expensive specialty drugs.
A number of different plans have been introduced that would raise the age of Medicare eligibility.[126][127][128][129] Some have argued that, as the population ages and the ratio of workers to retirees increases, programs for the elderly need to be reduced. Since the age at which Americans can retire with full Social Security benefits is rising to 67, it is argued that the age of eligibility for Medicare should rise with it (though people can begin receiving reduced Social Security benefits as early as age 62).
Core Plan covers the Part A coinsurance plus coverage for the first 90 days per benefit period (not including the Medicare Part A deductible) and the 60 Medicare lifetime reserve days, plus coverage for 365 additional days after Medicare benefits end, Part B coinsurance, first 3 pints of Blood each year, Part A Hospice coinsurance and certain state-mandated services.
A number of different plans have been introduced that would raise the age of Medicare eligibility.[126][127][128][129] Some have argued that, as the population ages and the ratio of workers to retirees increases, programs for the elderly need to be reduced. Since the age at which Americans can retire with full Social Security benefits is rising to 67, it is argued that the age of eligibility for Medicare should rise with it (though people can begin receiving reduced Social Security benefits as early as age 62). 

Depending on the state that you live in, you may not be able to get Medicare Supplement coverage if you’re under 65 and have Medicare because of disability, end-stage renal disease, or amyotrophic lateral sclerosis. States aren’t required to offer Medigap coverage to beneficiaries under 65. If you’re under 65 and enrolled in Original Medicare, check with your state’s insurance department to find out if you’re eligible to enroll in a Medicare Supplement plan.
"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."
When you apply for Medicare, you can sign up for Part A (Hospital Insurance) and Part B (Medical Insurance). Because you must pay a premium for Part B coverage, you can turn it down. However, if you decide to enroll in Part B later on, you may have to pay a late enrollment penalty for as long as you have Part B coverage. Your monthly premium will go up 10 percent for each 12-month period you were eligible for Part B, but didn’t sign up for it, unless you qualify for a special enrollment period.
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.

Starting January 1, 2020, Medigap plans sold to new people with Medicare won’t be allowed to cover the Part B deductible. Because of this, Plans C and F will no longer be available to people new to Medicare starting on January 1, 2020. If you already have either of these 2 plans (or the high deductible version of Plan F) or are covered by one of these plans before January 1, 2020, you’ll be able to keep your plan. If you were eligible for Medicare before January 1, 2020, but not yet enrolled, you may be able to buy one of these plans.


"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"."
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.

"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."
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