Special Needs Plan Services

Special Needs Plans Services Special Needs Plans (SNPs) offer different services and have different costs, like all Medicare Advantage (Part C) plans. All SNPs must provide Medicare drug coverage (Medicare Part D) as part of their benefits packages. Each plan will...

What is prior authorization?

What is prior authorization? Prior authorization is often times referred to as pre-approval or pre-authorization. Prior authorization is a process through which a request is submitted to a medical review contractor before the item or service is furnished to the...

I am a caregiver. What do I need to know?

I am a caregiver. What do I need to know to be of assistance to my loved one? A caregiver is an individual providing help, support, and/or assistance to someone who is either temporarily or permanently unable to function, or someone who can function but not optimally....

What Is a Guaranteed Issue Right?

Guaranteed issue right under the Medigap program refers to certain situations where by law, companies are required to offer you a Medicare supplement insurance plan regardless of your health status. Even if you have pre-existing conditions, Medicare Supplement...

What Are Cost-Sharing Plans?

Cost sharing is the portion of the costs covered by both you and your insurance company that you pay out of your own pocket. This cost ranges from deductibles, coinsurance, co-payments, or similar charges. Although, it does not include premiums, balance billing...

What is a Medicare Advantage PPO Plan?

A Preferred Provider Organization (PPO) is a type of Medicare Advantage plan (Part C) offered by a private insurance company. PPO plans typically require plan members to obtain health care services through one or more of its participating doctors, hospitals, and...

Why Was My Medicare Claim Denied?

Medicare sometimes will decide that a particular treatment is not covered and the beneficiary's claim will be denied. Many of these decisions are highly subjective and involve determining for example, what is "medically and reasonably necessary" or what constitutes...

What are cost-sharing plans?

What are Cost Sharing Plans?  Cost-sharing refers to how the costs of health plans are shared between the employer and the employee, this occurs when the employee has to pay for a medical service or health care cost that is not covered by his health insurance....