Things You Need To Know About Medicare Part C and Medicare Part D

Medicare Part C is a combination of the Medicare Part A and Part B options, which are categories of the Medicare program. Medicare approved private insurance companies offer Part C, a lower cost option as opposed to the original Medicare plan and offer additional benefits, also covering Part D or prescription drug coverage to a certain extent. In brief, anyone who joins Part C will have complete access to Part A and Part B.

Medicare Part C has its own network, so all the doctors and specialists that you can consult have to be a part of the Medicare plan. Under Part C, there is a primary doctor that refers the beneficiary to medical experts and specialists. One cannot consult doctors of his/her own choice; the beneficiary has to be within the group of medical experts assigned to the plan to avail Medicare services. If one chooses to consult out of this group, the treatment or visit may prove more expensive. Under Part C one co-pays for each doctor's visit.

Part C could also be referred to as the Medicare Advantage Plans. Different insurance companies develop different kinds of Part C plans. Some may include Part D or Prescription Drugs as well. There are a number of Part C plans, and most of them include PPO, MSA, PFFS, HMO and Medicare special needs.

Medicare Preferred Provider Organisation (PPO)

In a PPO, one has the freedom to choose his/her own medical providers (doctors and specialists) out of the network. The beneficiary might have to pay out of network charges but has the freedom to see medical experts without referral.

Medicare Medical Savings Account (MSA)

Under this plan, one can either use the High Deductible Plan, which will not provide coverage until the mentioned amount of deductible is met. The other is that, Medicare provides a savings account that it manages, to its beneficiary, which has a certain sum of money deposited into it exclusively for the purpose of health care costs.

Medicare Private Fee For Service (PFFS)

Here the beneficiary can see any doctor or specialist of choice without referral only if they concur with the terms, conditions and fees of the PFFS.

Medicare Health Maintenance Organisations (HMO)

Each beneficiary has an HMO network and can choose hospital(s) and medical providers from that network alone. One might require a referral from his/her primary care physician in order to see a specialist.

Medicare Special Needs

This plan is usually for persons with special health needs and chronic illnesses. A special plan must include Part A, B and D too.

Most Part C plans should have Part D or prescription drug coverage, but if one already has a separate Part D plan then, s/he cannot buy a Part C plan with drug coverage. An individual will need to buy a Part C plan with no drug coverage.

Medicare Part D

Anyone who is eligible for Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) is automatically eligible for Medicare Part D (Prescription Drugs). This means anyone who has Part D coverage gets the insurance company to pay for a section of his/her prescription medicines, regardless of the cost factor. A beneficiary who is outside the US territory and is in prison, will no longer be eligible to this section of Medicare.

Aanya, is an expert commentator on Medicare and Medicaid related information. For more information about Medicare Part C and Medicare Part D, visit http://www.emedicare.net/

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American National Insurance - 8:47 PM

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Management of Information Under HIPAA Laws - 4 Things

The Health Insurance Portability and Accountability Act (HIPAA) is concerned mainly with individuals and information concerning their health and insurance. It has enacted several laws to control the different situations where such information or individuals come in contact with certain parties called covered entities for particular purposes.

The following points will tell you more about the information involved and the provisions in the HIPAA laws for effective management of the same.

• Information: Information of a person includes all data that can identify the particular individual. Personal information will comprise of the name address, telephone numbers, e-mail addresses, social security number and date of birth. In addition all physical and mental health information from the past, present and future will be included. Furthermore data related to the health insurance, payment for any treatment received and other billing details will be incorporated. Such information is required by certain entities for administering proper treatment and processing your insurance. The information can be written, or be stored in an electronic format on a computer or may also be communicated verbally.

• Entities: Every individual will like to keep sensitive information to themselves; however you will be required to divulge such information to a handful of entities. These will mainly consist of healthcare providers like hospitals, nursing homes, clinics and professionals like doctors and psychologists who will need the data if they are to provide you with proper treatment. Similarly a health plan which includes insurance companies, company health plans or even government plans will require such information for managing your insurance and settling any claims. HIPAA has listed all such covered entities that access your data and requires them to follow a stringent set of rules so that only the bare minimum data is collected for the purposes that are specified beforehand.

• Communication: HIPAA laws further protect your information by asking the covered entities to take a number of precautions when storing and transacting such data. This includes allowing only the concerned personnel or entities to access sensitive information and taking the necessary safeguards against any unauthorized access during transmission. The law not only covers data in physical and electronic format but also what is conveyed verbally. Thus personnel like nurses, doctors and other hospital staff has to be equally careful when sharing such information.

• Personal Understanding: Educating yourself about the relevant HIPAA laws that affect you is the most effective way to protect personal information. You must ask the covered entity for a copy of the Notice of Privacy Practices (NOPP) which will tell you how your data will be managed and used. Also you will understand the scenarios where such information can be disclosed without your authorization and when your consent will be needed. In this way you will know if any violation has taken place and can approach the entity or higher authority to rectify the situation.

If you find it difficult to understand the HIPAA laws you can approach the entity and seek clarification, either way ensure that you keep track on how your data is being managed.

For more information, please visit our HIPAA website.

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American National Insurance - 9:33 PM

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3 Things You Should Know About the Health Insurance Portability and Accountability Act

The Health Insurance Portability and Accountability Act (HIPAA) of 1996 of the United States was brought in to revamp the health care and the medical insurance sector of the country. The act enables the user or the customer to have fair control over his or her personal and sensitive medical information. It protects the health insurance of the customer, even during events like loss of job or loss of existing cover.

With the way of life becoming more and more digitized, storage of sensitive information, sharing of information and maintaining databases has become important. The HIPAA's Privacy and Security Rule were framed to protect the privacy of the consumers and making the healthcare houses and the insurance providers more accountable with regards to the privacy of information. All customers and patients under the HIPAA must be well versed with the Privacy and Security Rule for their own benefits. The circulars and the notices must be read and understood. Listed below are three things one must know about the HIPAA.

• Covered Entities are required to give the customers the Right to Privacy. Covered entities, which are usually insurance firms or healthcare organizations, are the primary insurance providers. It is the responsibility of the covered entities to educate the consumers about the insurance they are planning to take, to educate them of their rights they are entitled to and explain to them about all about the HIPAA. Under the HIPAA, the customer or the patient entrusts the covering house with his personal and sensitive medical information. It is the duty and responsibility of the covered entity to protect the information and not share it with any one else without the consent of the owner of the insurance. The patient is also allowed to access his or her own records and make copies of it.

• Most of your personal and medical information is protected. As per the rules of the act, almost all personal and medical information is protected. This would include your conversations with your healthcare provider, conversations between doctors and nurses regarding your health and your billing information during the medical visit, along with other information which is registered with the health insurance provider.

• You must be aware of all the changes and amendments in the act. Time and again, updates, changes and amendments are made to the HIPAA. It is very important for the covered entity to understand the changes and bring out notifications to educate the customer. The Privacy Officer in the covered entity is required to bring out notifications. Updates may be in the form of emails, flyers, post or circulars. Periodically, a brief of the act should be sent to all the customers. Failure to inform the customer is an offense and the customer has the right to file a complaint under the act.

It is very important for all, the insurance providers, the patients and the healthcare organizations, to understand the HIPAA and its working. The patients need to know that their data is safe and protected and the insurance providers and health care houses need to respect the privacy and take all the necessary steps to protect the information.

For more information, please visit our HIPAA website.

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American National Insurance - 3:06 AM

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