Aug 28

Coverage Options For Medicare Eligible Individuals

People with Medicare can obtain their medical care through original Medicare or the Medicare Advantage Program (Part C). Medicare Advantage Plans consist of HMO, PPO, Private Fee for Service Plans and Special Needs Plans. Of the more than 10 million individuals enrolled in Medicare Advantage Plans, the majority are enrolled in HMO’s (Health Maintenance Organizations) which have been available since the 1980′s.

To help your parents (or you) make an informed decision, they need to understand how these plans work, and then decide which plan is right for them. The following is a brief description of each of the plan types.

Original Medicare
If an individual elects to go with traditional fee for service Medicare, they can generally use any doctor or hospital that accepts Medicare assignment anywhere within the United States. However, Medicare does have deductibles, copays and cost sharing requirements that can play havoc with budgets. To help pay these additional out of pocket expenses, many individuals purchase Medigap or Medicare supplement policies.

Medicare Advantage Plans (Part C)
If you opt to go with a Medicare Advantage Plan, you actually trade your traditional Medicare benefits for these plans. Many of the Medicare Advantage Plans are offered to eligible individuals at little or no cost other than continued payment of their Part B monthly premiums.

Medicare HMO’s (Health Maintenance Organizations)
These plans cover the same physician and hospital costs as traditional Medicare, but usually with lower out of pocket costs. HMO’s are attractive to Medicare eligible individuals because they often provide extra benefits like eyeglasses, hearing aids, and dental benefits which are not covered by traditional Medicare.

Individuals considering a Medicare HMO should be aware that they can only receive medical services from providers who are part of the HMO’s network of contracted providers. The HMO usually requires that an individual joining their plan select a primary care physician from those who participate in their network. This primary care physician would then be responsible for all medical care including referrals to a specialist and admittance to a hospital. The HMO will not pay for unauthorized visits to specialists nor non-emergency care received outside the HMO’s service area or visits to non-network physicians.

Medicare PPO’s (Preferred Provider Organizations)
These plans are private healthcare plans like HMO’s. However, PPO’s and HMO’s do differ into two very important areas. First, Medicare PPO’s do cover eligible medical care services obtained from doctors and hospitals outside the PPO network. And, second, Medicare PPO’s do not usually require that you obtain an authorization before seeking care from a specialist.

Regional PPO’s are available in many areas of the country. These plans serve large geographic areas and must offer the same premium costs and plan benefits to all individuals residing in these areas. Medicare PPO’s cover the same types of medical expenses that traditional Medicare does. In addition, Medicare PPO’s commonly include a prescription drug benefit. Unlike traditional Medicare, Medicare PPO’s have an annual out of pocket limit for benefits covered under Parts A and B of Medicare. The out of pocket limit caps the amount an individual can spend on covered medical expenses in a calendar year. As with any PPO program, when an individual uses a non-contracted provider for covered services, they will pay more out of their pocket.

Private Fee for Service (PFFS) plans
These plans are available to Medicare beneficiaries in exchange for their traditional Medicare Benefits. PFFS don’t have a formal network of doctors and hospitals to choose from and not all doctors or hospitals are willing to provide medical services to participants in these types of plans. If an individual is considering enrollment, it is wise to check with their doctor and local hospitals to make sure that they will accept the plan’s payment for services before enrolling. Also, the enrollee should thoroughly understand the benefits of a fee for service plan because the fee for service plans decide how much they will pay for Medicare covered services and may charge a higher cost sharing percentage than traditional Medicare. Private fee for service plans may include a prescription drug benefit. If they do not, the enrollee is free to join a Medicare stand alone prescription drug plan.

Special Needs Plans (SNP)
These plans are private plans that provide benefits to Medicare beneficiaries, including prescription drug coverage, who need additional help paying for their medical benefits. These would include individuals who qualify for both Medicare and Medicaid (MediCal in California), those residing in long term care facilities, and those with chronic or disabling medical conditions.

Medicare Prescription Drug Plans (Part D)
Prescription drug plans are available to all Medicare eligible persons regardless of medical history or income levels. When a person first qualifies for Medicare, their initial enrollment period begins three months before their 65th birthday, includes their birth month, and ends three months after their birth month. Otherwise, the annual open enrollment period for prescription drug plans runs from November 15th thru December 31st, with the coverage commencing on the following January 1st.

Medicare drug plans are designed to reduce drug costs for enrollees and protect against catastrophic drug costs. However, there is a monthly cost for these plans. In addition to a monthly premium, the covered individual is required to pay a percentage of the cost of the medications (or a copay) and Medicare pays part of the cost. Costs for a plan will vary depending on the medications taken and the type of plan selected. At a minimum, the plans available must provide a “standard” level of coverage.

For 2010, a standard prescription drug plan will have the following costs:
• A monthly premium which varies from approximately $24 per month to in excess of $100 depending upon the plan selected and medications taken.
• An annual deductible equal to the first $310 worth of prescription drugs.

After the annual deductible has been satisfied, the insured will pay the following amounts for the remainder of 2010:
• 25% of the cost for covered medications from $310 up to $2830 in charges, (the plan pays the other 75% of these costs); then
• 100% of the next $3842.50 in total drug charges (often called the donut hole or coverage gap); then
• After exceeding the annual of pocket limit of $4550, 5% of your drug costs or a copay of $2.50 or $6.30, whichever is greater for the rest of the current calendar year.

This describes a “Standard Plan.” Many of the prescription drug vendors do offer better benefit plans which forego the plan deductible and substitute copays instead of the 25% coinsurance. Generic medications are available for substantially less than brand names with these plans.

There is a penalty of 1% per month, using the average national premium, for non-enrollment/late enrollment, which is assessed for as long as they remain enrolled in the plan.

This has been just a brief overview of the benefits available to Medicare eligible individuals. For more detailed information, please consult the Medicare handbook, Medicare & You. The handbook is available by contacting Medicare at 1-800-MEDICARE1-800-MEDICARE or visiting the Medicare website at

Aug 27

Ways to Tell If A Medical Assistant Online School Is Genuine

These days, quality education is attainable with the use of the internet. You can study anywhere and anytime you want, even at the convenience of your own home. Many people are opting to study online because of the convenience and accessibility it gives. With that said, online schooling is one of the booming businesses today.

Online schooling has become a great business opportunity for many legal educators. However, it also attracts fraudsters who masquerades their illegitimate online schooling programs as official schools. Graduating from any of these illegitimate online schooling programs will just be a waste of time and money since you will not be recognized, accepted or become certified because these are not accredited by the Department of Education.

Here are useful ways on how to tell if a Medical Assistant Online School is genuine:

1. Check if the Medical Assistant Online School is included in the database of Accredited Post secondary Institutions and Programs of the Department of Education. For the list of accredited schools and programs, you can visit their website.

2. Check the website of the American Association of Medical Assistants at their website and see if the online school and programs you have selected are eligible to teach medical assistance and proctor CMA Certification Exam, an examination which all graduates of MA must pass before getting certified. The Commission on Accreditation of Allied Health Education Programs (CAAHEP) and the Accrediting Bureau of Health Education Schools (ABHES) are responsible for the accreditation of the MA programs that are eligible to proctor the CMA Certification Exam by the AAMA.

3. Some obvious signs in detecting a fake MA Online School are:

a. Their only requirement for admission is a valid credit card and they do not care about your G.P.A. and other school records. It only shows that they are only interested in your money!
b. They do not include entrance examinations and interviews as part of their admission procedure.
c. They do not have offices or schools located in the same country or location where they offer the degrees.
d. The list and/or qualifications of their faculty members are not shown.
e. Their quality of syllabus is not up to date.
f. You will receive the degree at a flat fee, unlike normal schools that has varying expenses depending on the educational program and charge per credit for tuition fees.
g. Promises that are too good to be true, like you will be able to receive a diploma within one to three months of program enrollment. Sometimes, you only have to pay for the degree, without the need to have a sufficient number of hours for studying.
h. They offer limited or no contact information such as mailing address or telephone numbers. They might even give a false or non-existent contact details.

Graduating from an illegitimate medical assistant online schooling program might be easy, but it is also worthless! Follow these procedures and you will surely find a genuine medical assistant online schooling program. Always remember that there are no short cuts on quality education. Having a good education is very critical, especially those who are practicing in the medical field because the lives of their patients are in their hands. Accreditation agencies such as the Commission on Accreditation of Allied Health Education Programs (CAAHEP) and the Accrediting Bureau of Health Education Schools (ABHES) make sure that educational standards are followed.

Aug 14

No Medical Exam Life Insurance – Top Tips For the Would-Be Policyholder

A no medical exam life insurance policy may well be the best type of coverage for you and your family. For instance, if you have been applying for a life policy to no avail, you may consider getting no exam insurance as your last resort. Just make sure that any previous illness you had is not serious or life threatening. Insurance companies will still check medical records and if they find out that you lied about your condition, your insurance could be cancelled. Another situation in which you may need no exam insurance is when you do not want to incur delays in getting insurance approval. But whatever your reason is, this type of policy can address your needs.

No medical exam life insurance policies only require a potential policyholder to answer a questionnaire that asks for his past and existing health condition and lifestyle. You need to be really honest when answering the questions because these will form the basis of whether the insurance company you picked will approve your policy or not. Do not worry if you experienced getting sick in the past. For as long as your health condition or lifestyle does not make you a very risky policyholder, there will be insurance companies that will consider you as eligible for no exam insurance packages.

The average cost of no medical exam life insurance policy can reach around $100,000. Some insurance coverage of this type can even go beyond this figure, especially if the applicant is over 40 years old or has preexisting conditions. Older folks can still apply for a no exam insurance package but they may have to pay higher and their coverage limits may be significantly lower compared to younger policyholders. It must also be pointed out that no exam policies offer one type of coverage, so if you want to get more benefits, you may still be required to undergo a physical exam.

Indeed, if you want to avoid all the hassles of getting insurance coverage, you can always turn to no medical exam life insurance. You will be in a perfect position for this kind of insurance if you are in tiptop health and if you do not practice habits that are proven to be bad for your overall wellbeing. But even without the usual paperwork, you still need to read the fine print in your no exam insurance policy. Just like in standard insurance packages, signing a no exam policy right away without understanding the whole contract can lead to problems later on.

Aug 12

Medical Billing Services Review

Financial strength of a health care provider is directly associated with the timely billing and reimbursement. Medical billing is the process by which health care professionals collect fees from the insurance company for the service provided to the patients. Health care professionals are so busy taking care of their patients; they have no time to worry about their billing. Finding a medical service provider is one of the most important tasks for a health care provider. Billing service providers help them by timely submission of the claims to the insurance company by taking a fee. They relieve the doctors from following up with insurance company, thereby helping them to concentrate more on practicing medicine. Hospitals do not need billing employees anymore. This has reduced the non-clinical staff requirements in the hospital.

For a long time, billing was entirely done on papers. But, paper documentation is a tedious and time consuming process. However, with the advent of software technology, billing has become much easier as medical service providers do electronic claiming. This helps them in fast and accurate claiming. Medical service provider’s duty includes verifying the insurance coverage, determining the eligibility, submitting the claim, following up the claims and contacting the patients and the insurance company to ensure the highest possible reimbursement. Health care providers who used quality medical billing service providers have seen improved performance in multiple dimensions, such as increased and fast collections, decreased denial of insurance and increased staff productivity.

Medical billers not only process the claims but also analyze the patient records to prepare customized report. They also advise the doctor on revised fee structure, new coding and ways to improve the medical practice as a business. Since medical biller’s duties involve complex areas such as bill collection, release of patient information and patient confidentiality, extreme care should be practiced while handling this area of billing service. A good sense of responsibility and consciousness of patient confidentiality is very essential for a medical biller.

A medical biller is expected to know good keyboarding, medical office procedures, medical insurance, medical terminologies, health care law and ethics and basic coding.

So, in a nutshell, medical billing service comes into picture each time a patient visits a health care provider. After each patient visits, medical biller reviews the bill attached to the patient’s record to establish which service was provided. Next, they check the insurance coverage and produce a customized invoice to the insurance company for the reimbursement. Medical billing service comes in handy to run a successful medical practice in a convenient way.

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