Monday, May 24, 2010

Medicare Coverage Choice :




There are Two Main Choices for How You Get Your Medicare


Follow These Steps to Help You Decide:

Decide if You Want Original Medicare or a Medicare Advantage Plan
 
Original Medicare
 
Step - 1
Part A (Hospital Insurance) and Part B (Medical Insurance)
 
  • Medicare provides this coverage.
  • You have your choice of doctors, hospitals, and other providers.
  • Generally, you or your supplemental coverage pay deductibles and coinsurance.
  • You usually pay a monthly premium for Part B.

Step - 2
Decide If You Want Prescription Drug Coverage (Part D)

  • If you want this coverage, you must choose and join a Medicare Prescription Drug Plan.
  • These plans are run by private companies approved by Medicare.
Step - 3
Decide If You Want Supplemental Coverage

  • You may want to get coverage that fills gaps in Original Medicare coverage. You can choose to buy a Medigap (Medicare Supplement Insurance) policy from a private company.
  • Costs vary by policy and company.
  • Employers/unions may offer similar coverage.



Medicare Advantage Plan (like and HMO or PPO)

Step -1
Part C – Includes BOTH Part A (Hospital Insurance) and Part B (Medical Insurance)

  • Private insurance companies approved by Medicare provide this coverage.
  • In most plans, you need to use plan doctors, hospitals, and other providers or you pay more or all of the costs.
  • You usually pay a monthly premium (in addition to your Part B premium) and a copayment or coinsurance for covered services.
  • Costs, extra coverage, and rules vary by plan.

Step - 2

Decide If You Want Prescription Drug Coverage (Part D)

  • If you want prescription drug coverage, and it's offered by your plan, in most cases you must get it through your plan.
  • If your plan doesn't offer drug coverage, you can choose and join a Medicare Prescription Drug Plan.
Continue Below

Note: If you join a Medicare Advantage Plan, you don’t need a Medigap policy. If you already have a Medigap policy, you can’t use it to pay for out-of-pocket costs you have under the Medicare Advantage Plan. If you already have a Medicare Advantage Plan, you can’t be sold a Medigap policy.



  • In addition to Original Medicare or a Medicare Advantage Plan, you may be able to join other types of Medicare health plans.
  • You may be able to save money or have other choices if you have limited income and resources.
  • You may also have other coverage, like employer or union, military, or Veterans’ benefits.






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Medicare physician fee schedule - Quick overview

Medicare Part B pays for physician services based on the PFS, which lists the more than 7,400 unique
covered services and their payment rates. Physicians’ services include the following:

* Office visits;
* Surgical procedures;
* Anesthesia services; and
* A range of other diagnostic and therapeutic services.


Medicare Physician Fee Schedule Payment Rates

Payment rates for an individual service are based on
three components:
1) Relative Value Units (RVU)
2) Conversion Factor (CF)
3) Geographic Practice Cost Indices (GPCI)


Medicare Physician Fee Schedule Payment Rates Formula


The Medicare PFS payment rates formula is shown below:

[(Work RVU x Work GPCI) + (PE RVU x PE GPCI) +
(MP RVU x MP GPCI)] x CF

Medicare fee schedule download