...Understanding Aetna Medicare Supplements Aetna Inc. controls subsidiary insurance companies that go by the brand name Aetna. The Medicare Supplement Insurance plans from this particular brand are insured by Aetna Health and Life Insurance Company. The big question is: what are these Medical supplement plans? How do they work? Who qualifies to enroll? What are the best options of Medicare supplement plans? Why do you need to enroll for the Medicare supplementary plans? When should I apply for the Medicare supplementary plans? Here is a dissemination of all the answers to these questions. What are Medicare supplementary plans? Medicare supplement plans, also commonly referred to as Medigap Insurance Policies, are designed to complement the Original Medicare Plan. If your Medicare Plan covers about 80% of your medical expenses, the Medicare supplement plans will go an extra mile in covering a certain percentage of the remaining 20% depending on the kind of Aetna Medicare supplement plan that you purchase from Aetna. The Medicare supplement plan will cover for copayments, coinsurance, yearly deductibles, and medical treatment costs that you incurred while outside the U.S. There is a difference between a Medigap Insurance policy and a Medicare Advantage Plan. The latter...
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...Medicare is the government medical coverage program for individuals who are 65 or more established, certain more youthful individuals with inabilities, and individuals with End-Stage Renal Disease (perpetual kidney disappointment requiring dialysis or a transplant, here and there called ESRD). On the off chance that you or your companion have worked all day for 10 or more years over a lifetime, you are likely qualified to get Medicare Part A for nothing. Section A spreads inpatient clinic stays, care in a talented nursing office, hospice consideration, and some home human services. What Medicare spreads is based upon, Federal and state laws, National scope choices made by Medicare about whether something is secured, neighborhood scope choices made by organizations in every state that procedure claims for Medicare. These organizations choose whether something is medicinally vital and ought to be secured in their general vicinity. Medicare Part B is accessible at a month to month rate set every year by Congress ($121.80 in 2016 for livelihoods $85000.00 or less for a person). Part B covers certain specialists' administrations, outpatient care,...
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...Medicare Project Author Note In 1965, U.S. President Lyndon B. Johnson passed the Medicare Benefit legislation as an amendment to the Social Security Legislation after 20 years of debating. Medicare is a health insurance program for U.S. citizens at least 65 years old, or those aged younger than 65 years who suffer from certain disabilities. In 1965, nearly half of the elderly had no health insurance and many others did not have enough coverage. That is when Medicare was enacted to help assure that almost all citizens at the age 65 or older would have health care coverage. The program was modeled on the standard employer sponsored health plans of the day. As the Nation moves into the 21st century, Medicare is facing serious financial challenges. Over the next 50 years the number of beneficiaries are expected to more than double while the ratio of workers, whose payroll taxes fund over half of the program, to beneficiaries is expected to decline from about 4 to 1 to a little over than 2 to 1. In recent estimates from the Congressional Budget Office and the Administration predicted that the program will be bankrupt about the time the growth in beneficiaries accelerates as the baby boom generation started to become eligible in 2010. People seem to get Medicaid and Medicare confused. Medicare and Medicaid are both government sponsored programs designed to help cover healthcare costs. Both programs were established by the U.S. government in 1965 and are taxpayer funded, they...
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...Medicare versus Medicaid A Brief Comparison Medicare versus Medicaid: A Brief Comparison The Federal government has two distinct programs to provide health insurance coverage to citizens, Medicare and Medicaid. The two programs, while helpful to those individuals who qualify, are not available to everyone. In this paper, I will briefly define and discuss the two programs, their similarities, and their differences. The first program I will discuss is the Medicare program. President Johnson signed Title XVIII of the Social Security Act, also known as Medicare, into law on July 30, 1965 with coverage beginning in 1966. When Medicare first began, it consisted of two basic parts, known as Part A, and Part B. Medicare Part A provides hospitalization coverage automatically to all citizens age 65 and older. It 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. Most people do not have to pay a premium for this service because they or their spouse has already paid for coverage through payroll taxes. (Medicare Gen Info) For those who do not qualify for premium free service, an annual deductible of forty dollars per year was established. . Since then, like everything else, Medicare Part A premiums have increased. “The $1,024 deductible for 2008, paid by the...
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...CENTERS FOR MEDICARE & MEDICAID SERVICES Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare This official government guide has important information about: • What is a Medicare Supplement Insurance (Medigap) policy • What Medigap policies cover • Your rights to buy a Medigap policy • How to buy a Medigap policy This guide can help if you’re thinking about buying a Medigap policy or already have one. 2013 Developed jointly by the Centers for Medicare & Medicaid Services (CMS) and the National Association of Insurance Commissioners (NAIC) How to use this guide There are 2 ways to find the information you need: 1. The “Table of Contents” on pages 3–4 can help you find the sections you need. 2. The “List of Topics” on pages 53–56 lists topics in this guide and the page number of where to find them. Who should read this guide? This guide helps people with Medicare understand “Medicare Supplement Insurance” policies (also called Medigap). A Medigap policy is a type of private insurance that helps you pay for some of the costs that Original Medicare doesn’t cover. Table of Contents Section 1: Medicare Basics 3 5 A brief look at Medicare. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 What is Medicare? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 The different parts of Medicare . . . . . . . . . . . . . . . . . ...
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... Instructor: HENRY PROVENCHER Medicare is a national social insurance program, administered by the U.S. federal government since 1965, which guarantees access to health insurance for Americans ages 65 and older and younger people with disabilities as well as people with end stage renal disease (Medicare.gov, 2012). Medicare is a program that offers everyone a well defined benefit that includes different hospital parts. The Medicare parts are: Part A, Part B, Part C & Part D. Part A is known as hospital insurance. This part covers medical necessary such as hospital stay, nursing home, home health care and also hospice care. Medicare Part A is free to people who have worked and paid in Social Security for at least 10 years. There will be a monthly premium charge if you have not worked for at least 10 years and paid Social Security taxes. Part B is medical insurance that covers things such as doctor visits, medical equipment and various other forms of other outpatient services. Part B also covers mental health care and ambulatory services. To receive the Part B medical insurance you have to pay a monthly premium. Part C is the portion of your policy that allows private insurance companies to cover your medical expenses. This includes private health plans such as HMOs and PPOs. To cover the Part A and Part B benefits, Medicare offers a choice between an open-network single payer health care plan and a network plan where...
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...Plan F is a type of Medicare supplement insurance plan. The other type is plan G. These plans cover certain costs known as Medicare part B over charges. An over charge is simply the difference between the amount that Medicare pays and what the doctor or the provider charges. The Medicare supplement plan F protects someone from the additional expenses especially if you are required to have treatment that is above what the Medicare will approve. Plan F is also known to have high deductible option. Both plan F and G cover all the excess charges of the Medicare part B. With Medicare supplement plan F, one gets the full coverage available. Since the plan covers the excess costs of Medicare approved amounts, one can have no pocket costs for doctor’s...
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...Medicare Fraud: The History, Incidence, Costs and Institutional Remedies John H Everett Wayland Baptist Medicare Fraud: The History, Incidence, Costs and Institutional Remedies What is Medicare fraud? ("F&A," 2011, p. 1) states “Medicare fraud happens when Medicare is billed for services or supplies you never got. Medicare fraud costs Medicare a lot of money each year.” What is Medicare abuse? ("F&A," 2011, p. 1) defines this as “Abuse occurs when doctors or suppliers don’t follow good medical practices, resulting in unnecessary costs to Medicare, improper payment, or services that aren’t medically necessary.” In reviewing the definitions of fraud and abuse by Medicare it may be hard for some people to understand if they do not live in the healthcare world daily. In an effort to help shed some light on this, we will look at the history of Medicare fraud. It has been around since the Civil War, when the False Claims Act (FCA) was created. It was also called the Qui Tam Statue meaning “he who sues for the king as himself.” ("FCA," 2011, p. 1) “The law was targeted at stopping dishonest suppliers to the military Union military at a time when the war effort made it all but impossible for the government to investigate and prosecute the fraud itself. Today it serves a similar purpose because of the enormous size of the federal government and the variety or programs under which it expends taxpayer funds.” In 1986 the FCA has been revised over the...
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... As the newly appointed chief of staff I have been tasked with responding to a proposal for reducing Medicare expenditures by enrolling participants in HMO. I understand that we have some key questions must be addressed and that we must justify our position on either economic efficiency or equity grounds. Outlined below are some of the questions that must be answered in order address this issue properly. Is Medicare in a state of crisis? Are you aware of the various policies that are being enacted from each state to state regarding the qualification of Medicare? Medicare is funded by the federal government and each state is responsible for operating the Medicare program as well as the local Medicaid programs. However, premiums have increased for Medicare and also, the coverage has changed in the past few years requiring people to purchase additional supplemental Medicare policies - this is difficult for elderly that have fixed incomes. If the elderly are unable to purchase Medicare, they will go uninsured. The Medicare system is double-funded. It is funded by the taxpayer (federal dollar) as well as the premiums being collected. But, in being double-funded, the coverage is still not as high as most private insurance companies making them appear with less quality. Are radical measures necessary to preserve the program? This is a very interesting question and you will have to take a more subjective approach to answering it. I don't believe there are radical measures...
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...Rolunda Baker Medicare Crisis Medicare is another project of Lyndon Baines Johnson Great Society. Spending is obviously out of control. On June 5th the government announced that the Medicare Trust Fund would go broke if something isn’t done with the spending (nationaldebt). In 1965 when LBJ started Health and Medicare, the Total Federal Spending for the year was $101 Billion. By the year 2000 we will spend over 4 times than amount on Health and Medicare alone, and Medicare will equal the annual spending for Defense (CNN). Medicare was a program that was not acceptable gracefully by the Liberal/Socialists. You might keep this in mind when we get to the point where we have to choose what we CAN do versus what we would LIKE to do. According to CMS the government predict that if healthcare keeps going the in the current direction the cost of Medicare will have exceeded defense spending, unlike other Healthcare systems the US healthcare has been a problem for the government as well for it has added to the enormous debt the country already has. Another major problem of Medicare is that the government does not regulate Medicare enough (Medicare). Medicare affects all different aspects of different programs. For instance Medicare affects Social Security (national debt). Social Security has already exceeded Defense spending by almost double. Just like Medicare, Social Security is being abused. So many people abuse the system, by that i mean people take advantage of it. It is different...
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...Staff Date: January 18, 2015 Subject: Medicare Crisis Congressman Hughes, You have been asked to participate in a panel discussion concerning the Medicare crisis and how expenditures can be reduced. One proposal that is being considered is enrolling participants in HMOs. This memorandum contains information about the Medicare crisis and it will assist you in answering questions that the panel may have, and also aid you in making decisions concerning enrollment in HMOs. PROBLEM IDENTIFICATION The Medicare and Medicaid programs were signed into law on July 30, 1965, by President LBJ. When it was first implemented, Medicare covered most people aged 65 or older. "In 1973, the following groups also became eligible for Medicare benefits: persons entitled to Social Security or Railroad Retirement disability cash benefits for at least 24 months, most persons with end-stage renal disease (ESRD), and certain otherwise non-covered aged persons who elect to pay a premium for Medicare coverage." (Annual Statistical Supplement, 2011 - Medicare Program Description and Legislative History, 2011 para 2) Medicare consists of four parts: Hospital Insurance (HI), also Medicare Part A. Medicare part B is helps pay for physician, outpatient hospital, home health agency and other services. Medicare is Medicare Advantage Program which is a program that expands beneficiaries' options for participation in private-sector health care plans. Medicare D helps pay for prescription drugs that...
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...Social Security and Medicare History Present Configuration Future Projection GERO100 March 31, 2012 Hopefully we will all be physically able to work until the age of 65, collect retirement and Social Security and live an enriching life until we leave this world. Not all companies financially support their employees with fully funded retirement plans so it is left up to the individual to actively participate in saving for their future. When someone reaches retirement age, if the finances are there, they are usually only a fraction of what they were making as a full-time employee. This is when one hopes of having Social Security and Medicare benefits to supplement our retirement income for a more stable financial future. There are several reasons the Social Security Act was passed in August 1935. The elderly were living longer due to the availability of better health care, autonomy in workplaces to make jobs easier on individuals, and the modernization of our country’s water systems. Due to this increased longevity in the lives of the elderly, they were also more poverty stricken. An intention of the passage of the Social Security Act was to reduce the burden of loss of income to retired workers aged 65 or older. (Quadagno, 2008) It also included provisions for unemployment insurance, old age assistance and aid to dependent children. Benefits were to be paid based on the primary worker and was to be funded through payroll taxes deducted from the worker’s...
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...interviewing three generation of women my mother an 85 year old, my sister a 60 years old and my niece a 37 years old. When referring to health care in this interview we will be discussing inpatient care, outpatient care and long term care. What is your name and age? What has been the biggest barrier to healthcare for you? Understanding the healthcare system in itself has been a hurdle for me to conquer. Medicare Part A, B, C, and D. (non-financial hindrance to access healthcare) How do you see healthcare in America today? If we had a more nationalized healthcare system, we could do a better job for our patients and physicians would feel more satisfied with their jobs. How has the ACA affected you? situation or obstacle you have overcome What do you think the future holds for aging in Canada? ie) you could refer to Baby Boomers, technological advancements that could prolong life, cure for diseases etc. What steps have you taken to prolong your overall wellbeing? ie) diet, exercise What are your feelings towards living on your own? Can you see yourself eventually moving into a retirement or care facility? Why or why not? What are you enjoying...
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...Medicare Exhaust Billing Procedure Manual Project Cynthia Gause Colorado Technical University Online ENGL205-1301 Technical Writing and Speaking Phase 4IP Contents Contents 1 Phase 1 IP 2 Procedure Manual Outline 2 Phase 2 IP 3 Procedure Manual Proposal (Revised) 3 Brochure 4 Brochure Continued 5 Phase 3 IP 6 Medicare Exhaust Billing Checklist 6 Procedure Manual 7 Preparing Bill 3 Step I – Census 3 Step II – Bill Upload 4 Exhaust Billing Claim Coding 5 Step III- Xclaim 5 DDE Step IV 7 Secondary Claim Submission 8 How to submit Secondary Exhaust Claim 8 UB04 Claim examples 8 Billing Reference Tools 10 Type of Bills 11 Patient Status Codes 12 DDE Access/ Menu 13 Phase 1 IP Procedure Manual Outline Outline for Medicare Exhaust Billing Procedure Manual I. Introduction This section will provide an overview of Medicare exhaust billing and the purpose of this manual. II. Bill Uploads Upload bill and billing data in the Ram system to allow bills to be created. III. Claim Coding, and required remarks Once bills have been uploaded and created, bills need to be coded correctly and remarks need to be added to the claim. IV. Submit Bill to Medicare thru Xclaim...
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...| Medicare Funded Organ Transplants | Ethical Issues | | Pamela Caldwell | 10/16/2011 | Keller Graduate School of Management | Medicare Funded Organ Transplants: Ethical Issues Introduction “Ethical issues are the branch of philosophy that defines what is good for the individual and for society and establishes the nature of obligations, or duties, that people owe themselves and one another. In modern society, ethics define how individuals, professionals, and corporations choose to interact with one another.” (Ethics, Legal legal definition of Ethics, Legal. Ethics, Legal synonyms by the Free Online Law Dictionary.) The ethical issue with Medicare funded organ transplants is who it should be eligible and the problem that the needed immunosuppressant drug is only available for a limited amount of time through Medicare funding. The value of a person’s life has been fragmented down to if they have worked long enough, have enough wealth and/or resources to deserve an organ transplant; and the required drugs. This is troublesome in the regard to should everyone have an equal shot to a prolonged life and quality of care. Only those who have the ability to pay will be put on the waiting list for an organ. Define Problem How can Medicare better handle the ethical issues faced with funding organ transplants and the medication needed? “Since 1973, end-stage renal disease has been the only condition specifically covered by Medicare regardless of age...
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