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The Medicare Giveback Benefit is a Part B premium reduction provided by some Medicare Advantage Part C plans. If you enroll in a Medicare Advantage plan with this benefit, some or all your monthly premium will be covered by the plan carrier. The standard part B benefit cost in 2023 is $164.90. The plan carrier will reduce your costs by “giving back” anywhere from $1 to the full Part B premium amount. Who is eligible for a Medicare Advantage plan with a Part B rebate? To be eligible you first must be enrolled in Medicare Part A and Part B. You must also pay your own Part B premiums. You are not eligible if you receive Medicaid or any other government assistance that helps you pay your Part B premium cost. The Part B rebate may be restricted to certain zip codes in your state. Some plans may not offer coverage in your area. This is because Medicare Advantage plans are offered by private insurance companies who have defined geographic service areas. Currently, 48 U.S. states offer this benefit. How do I receive the Medicare Giveback Benefit? If you pay your Medicare Part B premium through Social Security, the Part B Giveback will be credited to your Social Security check monthly. If you don’t pay your Part B premium through Social Security, you’ll pay a reduced amount directly to Medicare. Could your plan change its premiums? Yes, even though private insurers must follow Medicare’s rules for coverage in their Medicare advantage plans, they each set the fees they charge for premiums, services, and deductibles. This can only take place once per year on January 1st. Be sure... read more
People with Medicare can get their health coverage through either Original Medicare or a Medicare Advantage Plan (also known as a Medicare private health plan or Part C). Both Medicare and Medicare Advantage are legally required to cover certain basic health services, though the costs you pay and the specific services that are covered vary. Medicare vs. Medicare Advantage: Differences: Original Medicare. If you or your spouse worked and paid Medicare taxes, you will most likely receive Part A premium-free with Original Medicare. Part B with Original Medicare has a premium ($170.10 in 2022) and a deductible ($233.00 in 2022). Part B costs are based on your lifetime earnings, so low-income beneficiaries may pay less. With Original Medicare, you can see any medical provider or visit any facility in the country that accepts Medicare. According to the Kaiser Family Foundation, 93 percent of primary physicians participate in Medicare Under Part B, beneficiaries are responsible for 20 percent of a doctor visit or lab test bill. There is no out-of-pocket maximum for Original Medicare. A Medigap plan (also called a Medicare Supplement), sold by private companies, can help pay some of the 20 percent Original Medicare doesn’t cover. Original Medicare does not include prescription drug coverage. You may choose to purchase a stand-alone prescription drug plan from a private company. Medicare Advantage. Medicare Advantage is a bundled alternative, you will essentially be joining a private insurance plan like you likely had through your employer. Instead of paying the 20 percent coinsurance amount for doctor visits and other Part B services, most MA plans have set copay amounts for each physician visit. The copays, deductibles and other out-of-pocket costs that can make... read more
As a patient who takes control of your healthcare, it is important to know the terms and conditions around when a prior authorization is needed. The range can be significant – some health plans only require authorization for major elective medical services, while others may require an authorization for nearly any service that is non-emergent as well as many drugs. Prior authorizations, also known as pre-certifications, are used within the healthcare industry to ensure that an insurance company has some level of control over the medical services that its members seek. And to ensure that a patient isn’t having an elective MRI every 3 months for no medical reason, or that they aren’t getting brand name prescriptions at $15,000/month when a generic at $5,000/month will do, health insurance plans build in the extra step of authorizations. Our advice, when in doubt, is to call your health insurance plan and verify that you do or don’t need an authorization. There is typically a phone number on your insurance card dedicated to authorization questions, and especially on potentially high-dollar services, using that number could save you significant money. We also recommend that any time you call for an authorization, ask the person you talk to document the discussion in their system, and be sure to document it on your own as well. Include the number you called and the name of the health insurance employee who you spoke with. If you do receive an authorization, it will either be given in the form of a number or a document. If a number, you will need to keep it for your records... read more
An EOB, or a Remittance Advice, is the documentation from your insurance company showing how they processed your claim. It should show the amount billed by your provider, the amount paid to your provider per the contract, any reasons for not paying or for denying part of the claim, and the amount that you owe. The EOB is an important document to have available if you need to discuss your bill with your provider or your insurer. There is no standard format for EOBs, but they all have generally the same elements. What is a denial from an insurance? Sometimes your insurer processes your claim and determines that they are not going to pay part or all of it. This is known as an insurance denial or rejection. When your service is denied, you will usually receive an EOB with a code or description explaining why it was denied. In many cases, an insurance denial may become your responsibility to pay. Why would my insurance deny service? Services are denied for many reasons, usually accurately but sometimes inaccurately. Common reasons why your claim may be denied include duplicate bills (the insurer was billed twice for the same service), the service was not covered by your plan, or the treatment was miscoded by your provider. These are just a few of the reasons – there could be dozens, but it should be clearly communicated on the EOB. How long should it take for the claim with my insurance to be resolved? It depends on several factors, but most claims which have no major issues are resolved within 45 days. What... read more
What is the difference between an HMO, a PPO, Point-of-Service plan, Indemnity, and other choices? If you are lucky enough to have several options to choose from when selecting health insurance, you’re probably faced with a decision of which type of plan to go with. We’ll try to simplify this, because even within the healthcare industry the lines are fuzzy and blurry. Think of these plans as less of unique entities, and more of a gradient of options that have some overlap in them. In simplest terms, you as the buyer of a health insurance plan need to make a choice: What kind of flexibility do you want in your health coverage, and what price are you willing to pay for it? After you sort out the fine print and term limitations, it all comes down to that. We’ll list the plans from high-flexibility, high-price to low-flexibility, low-price. Remember, this is just a general guide. Your health plan options may be quite different, and increasingly they will not even go by the acronyms listed below – insurance companies are always trying to find more attractive names for their offerings, such as “Choice“, “Plus“, or “Value“. When comparing your health plans in an employee handbook, skip over the text and go straight to the comparison tables where you can see the plans side-by-side. That is where the differences emerge. Health Maintenance Organization (HMO). An HMO typically is the lowest-cost option that you’ll find, with the exception of a High Deductible Health Plan (HDHP) / Health Savings Account (HSA) option, which is really a different approach altogether. HMOs typically have you choose... read more
Flexible Spending Accounts (FSAs) are accounts specifically setup to allow workers to spend pre-tax dollars on health expenditures. FSAs are very common, approximately 9 of every 10 employers offered an FSA option for their employees. Unless you are self-employed or unemployed, the odds are that you can use an FSA to help decrease the cost of your healthcare spending. An FSA is commonly operated through an administrating company, which may or may not be the same administrator of other employee benefits. FSA dollars may be spent on eligible health expenses, on insurance premiums, or on eligible dependent care expenses. With most employers, sign-up for FSAs occur during the benefits open enrollment period, or during a “life change” window such as a marriage or the birth of a child. Like Health Savings Accounts (HSAs), FSAs are intended solely for health expenses and are regulated. The process for saving and spending FSA dollars are dictated by federal policy, and in many cases your employer or administrator may have additional regulations or requirements. Unlike HSAs, FSAs are offered employees regardless of which health plan they choose (an HSA is only available to employees who also choose a qualified High Deductible Health Plan). While HSAs build and grow from year-to-year like a 401k or IRA, FSAs have a “use it or lose it” provision. The dollars saved must be spent within the same benefit... read more
CDC and Humana Partner to Create Next Generation of Public Health; Alliance to Leverage Private-Sector Resources to Address Chronic Diseases. The Centers for Disease Control and Prevention (CDC) and Humana Inc. (NYSE: HUM), the nation’s leading consumer-oriented health benefits company, have entered a partnership with the aim of expanding on traditional private- sector approaches to population health management. The partnership will leverage Humana’s resources and technologies, including the ability to discover, target and intervene on individual health risks and the expansion of that capability to the entire U.S. population. “As an industry we need to make a greater commitment to addressing chronic diseases and the costs they impose on our healthcare systems and individual well-being,” said Dr. Jonathan Lord, Humana’s senior vice president and chief innovation officer. “Among the initiatives we will focus on are ways to use public health data to predict and identify those at risk for diabetes and other chronic diseases.” The University of Miami–Humana Health Services Research Center will lead the research effort with an initial focus on health screening tools and chronic disease interventions using voice activated technology, mobile phone applications and social and community-based interactions. A particular focus will be on expanding current work being conducted at the Center that correlates the effects of wellness programs to reductions in weight, increased activity levels and lower medical claims costs for employer groups. The partnership will expand upon that body of work by further analyzing Humana’s rich medical and lifestyle data to refine the CDC’s Healthy Workforce USA program, a new initiative from the CDC Office of Innovation that will define best practice metrics and program components... read more
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