Medicare Advantage Application

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This page provides important information on the application process for Part C Medicare Advantage plans (HMO/HMOPOS, PPO, RPPO, PFFS, MSA, EGWP and SNP). Please use the Medicare Prescription Drug link in the “Related Links Inside CMS” section below to access Medicare Prescription Drug application materials.

MY Medicare Contract Applications – Organizations that are interested in applying for a Medicare Advantage contract can download and complete the appropriate application.

Medicare Advantage Plans

Medicare Advantage plans have become popular since their creation in the 2003 Act passed by congress. These plans are a partnership between the government’s Medicare program and private insurance companies. Medicare Advantage plans are like HMO’s where if you go to doctors within a system, you get enhanced benefits. These plans will also include the Part D prescription drug program at no additional cost.

Technically insurance agents and sales people are not supposed to say that the Medicare Advantage plans are free. But they do not cost any more than an individual would already pay if they had Part A and Part B of regular Medicare. So as long as a patient pays their Part B premium for doctor benefits, they can get a Medicare Advantage plan structure at no additional cost. MyMedicare.Gov

Essentially benefits such as Part D, copayments for doctor visits, and copayments for hospital stays included in these plans are free. The reason that insurance companies can offer these plans is that the government provides a subsidy for each additional subscriber that they get to sign up for a Medicare Advantage HMO plan. The government pays the insurance company a monthly amount to provide benefits and pay claims for people on Medicare. The idea was that the insurance companies would relieve the Medicare system of some of the expensive claims by letting the insurance companies manage the risk. These plans cover people with good benefits in network, but out of network, many times coverage is limited.

Right now and since their inception, the subsidy has been so high that the major insurance companies have flooded this market with marketing and sales teams the size of an army. All of these plans are very good. Any Medicare is good if you can get it. But the success of these plans depends on the subsidy from the government. The amount of benefits they provide will be directly related to the amount of the subsidy for each person. As the federal government cuts the subsidy, the insurance companies will begin to cut benefits. MyMedicare.Gov

So while these Medicare Advantage plans don’t cost the person applying for the plans, each person on the plan is worth a certain dollar amount each month to provide the benefits. While it doesn’t cost the person more, the government pays. Hopefully the next time someone tells you Medicare Advantage plans with extra benefits are free, you will know why.

MyMedicare.Gov – Brian W. Thacker has been working with individuals and their families to meet their medical insurance needs since 1996. He brought the agent appointment and application process to the web in 1998 with his website health insurance. He has clients all over the world who have used his websites to get quotes and info about a variety of options from medical insurance to Medicare and Family plans. Get a quote and apply online in minutes. Your coverage can be in place by midnight and you get your cards sooner than that.

Beneficiary Notices Initiative (BNI)

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Please Note: For Medicare Prescription Drug Coverage Notices — see below under “Related Links Inside CMS.”

Beneficiary Notices Initiative

Both Medicare beneficiaries and providers have certain rights and protections related to financial liability under the Fee-for-Service (FFS) Medicare and the Medicare Advantage (M.A) Programs. These financial liability and appeal rights and protections are communicated to beneficiaries through notices given by providers. MyMedicare.Gov

Use the navigation tool on the left side of this page to link to the following financial liability notices and their instructions:

  • FFS Revised Advance Beneficiary Notices (FFS Revised ABN)
  • FFS Home Health Advance Beneficiary Notice (FFS HHABN)
  • FFS Skilled Nursing Facility Advance Beneficiary Notice (FFS SNFABN) and SNF Denial Letters
  • FFS Hospital-Issued Notice of Noncoverage (FFS HINNs)
  • FFS Expedited Determination Notices for Home Health Agencies, Skilled Nursing Facility, Hospice and Comprehensive Outpatient Rehabilitation Facility  (FFS ED Notices)
  • MA Denial Notices (MA Denial Notices)
  • MA Notice of Discharge and Medicare Appeal Rights (MA NODMAR)
  • MA Expedited Determination Notices (M.A ED Notices)
  • Important Message from Medicare
  • FFS Notice of Exclusion from Medicare Benefits (FFS NEMB)
  • FFS Notice of Exclusion from Medicare Benefits – Home Health Agency (FFS NEMB HHA)
  • FFS Notice of Exclusion from Medicare Benefits – Skilled Nursing Facility (FFS NEMB SNF)

Source: Medicare Infomation

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Telehealth

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We make any additions or deletions to the services defined as Medicare telehealth services effective on a January 1st basis. The annual physician fee schedule proposed rule published in the summer and the final rule (published by November 1) is used as the vehicle to make these changes. The public has the opportunity to submit requests to add or delete services on an ongoing basis.

Because C.M.S intends to use the annual physician fee schedule as a vehicle for making changes to the list of Medicare telehealth services, requestors should be advised that any information submitted, are subject to disclosure for this purpose. Source: Telehealth

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Medicare Health Support (formerly CCIP)

MyMedicare.Gov – Section 721 of the Medicare Modernization Act of 2003 (MMA) authorized development and testing of voluntary chronic care improvement programs, now called Medicare Health Support, to improve the quality of care and life for people living with multiple chronic illnesses.    Chronic conditions are a leading cause of illness, disability, and death among Medicare beneficiaries and account for a disproportionate share of health care expenditures.

About 14 percent of Medicare beneficiaries have heart failure, but they account for 43 percent of Medicare spending.  About 18 percent of Medicare beneficiaries have diabetes, yet they account for 32 percent of Medicare spending.  The initiative assessed whether the benefits of better managing and coordinating the care of these beneficiaries would result in reduced health risks, an improved quality of life, and savings to the Medicare program and the beneficiaries.MyMedicare.Gov

The programs were overseen by the Centers of Medicare and Medicaid Services (C.M.S) and operated by health care organizations chosen through a competitive selection process.  Phase I program operations began between August 2005 and January 2006.  Phase I ended on August 31, 2008 and CMS is assessing the results of this program. Source: Medicare Health Support

 

Medicare Approved Facilities/Trials/Registries

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In recent years, Medicare has issued several national coverage determinations providing coverage for services and procedures of a complex nature, with the stipulation that the facilities providing these services meet certain criteria. This criteria usually requires, in part, that the facilities meet the minimum standards to ensure the safety of beneficiaries receiving these services in order to be considered as a provider with the ability and expertise to perform the procedure. Being certified as a Medicare approved facility is required for performing the following procedures: carotid artery stenting, VAD destination therapy, bariatric surgery, certain oncologic PET scans in Medicare-specified studies, and lung volume reduction surgery. source: Medicare Approved Facilities

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Medicare Program – General Information

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People with Medicare, family members, and caregivers should visit Medicare.gov, the Official U.S. Government Site for People with Medicare, for the latest information on Medicare enrollment, benefits, and other helpful tools.

Medicare is a health insurance program for:

  • people age 65 or older,
  • people under age 65 with certain disabilities, and
  • people of all ages with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant). Medicare Program

Medicare has:

Part A Hospital Insurance – Most people don’t pay a premium for Part A because they or a spouse already paid for it through their payroll taxes while working. Medicare Part A (Hospital Insurance) helps cover inpatient care in hospitals, including critical access hospitals, and skilled nursing facilities (not custodial or long-term care). It also helps cover hospice care and some home health care. Beneficiaries must meet certain conditions to get these benefits. Medicare Program

Part B Medical Insurance
– Most people pay a monthly premium for Part B. Medicare Part B (Medical Insurance) helps cover doctors’ services and outpatient care. It also covers some other medical services that Part A doesn’t cover, such as some of the services of physical and occupational therapists, and some home health care. Part B helps pay for these covered services and supplies when they are medically necessary. MyMedicare.Gov

Prescription Drug Coverage – Most people will pay a monthly premium for this coverage. Starting January 1, 2006, new Medicare prescription drug coverage will be available to everyone with Medicare. Everyone with Medicare can get this coverage that may help lower prescription drug costs and help protect against higher costs in the future. Medicare Prescription Drug Coverage is insurance. Private companies provide the coverage. Beneficiaries choose the drug plan and pay a monthly premium. Like other insurance, if a beneficiary decides not to enroll in a drug plan when they are first eligible, they may pay a penalty if they choose to join later.(source: Medicare Program)

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