Insurance Applications Group Inc (IAG Benefits) is a nationwide employee benefits design and communications firm that specializes in programs designed for the staffing, temporary employee. Essential StaffCARE specializes in the development of insurance products, benefit communication and administrative systems for the Staffing Industry. Essential StaffCARE is the largest provider of health insurance and benefit plans to the Staffing Industry, enrolling. The following note on Essential Staff Care insurance provides important information about these plans. How the MV and MEC Plans Work (Click here to see the Coverage Solutions for Today) These plans are considered selfinsured policies however, they are “max funded”. This means that you do not have any financial liability beyond the “fully.
MediGold Essential Care (HMO) H3668-019 is a 2021 Medicare Advantage Plan or Medicare Part-C plan by MediGold available to residents in Ohio. This plan includes additional Medicare prescription drug (Part-D) coverage. The MediGold Essential Care (HMO) has a monthly premium of $0 and has an in-network Maximum Out-of-Pocket limit of $4,900 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $4,900 out of pocket. This can be a extremely nice safety net.
MediGold Essential Care (HMO) is a Local HMO. With a health maintenance organization (HMO) you will be required to receive most of your health care from an in-network provider. Health maintenance organizations require that you select a primary care physician (PCP). Your PCP will serve as your personal doctor to provide all of your basic healthcare services. If you require specialized care or a physician specialist, your primary care physician will make the arrangements and inform you where you can go in the network. You will need your PCPs okay, called a referral. Services received from an out-of-network provider are not typically covered by the plan.
MediGold works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for MediGold Essential Care (HMO) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from MediGold and not Original Medicare. With Medicare Advantage Plans you are always covered for urgently needed and emergency care. Plus you receive all of the benefits of Original Medicare from MediGold except hospice care. Original Medicare still provides you with hospice care even if you sign up for a Medicare Advantage Plan.
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2021 MediGold Medicare Advantage Plan Costs
|Monthly Premium C+D:||$0|
|Part C Premium:||$0|
|Part D (Drug) Premium:||$0|
|Part D Supplemental Premium||$0|
|Total Part D Premium:||$0|
|Tiers with No Deductible:||0|
|Benchmark:||not below the regional benchmark|
|Type of Medicare Health:||Enhanced Alternative|
|Drug Benefit Type:||Enhanced|
MediGold Essential Care (HMO) Part-C Premium
MediGold plan charges a $0 Part-C premium. The Part C premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.
H3668-019 Part-D Deductible and Premium
MediGold Essential Care (HMO) has a monthly drug premium of $0 and a $0 drug deductible. This MediGold plan offers a $0 Part D Basic Premium that is not below the regional benchmark. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits. The Part D Supplemental Premium is $0 this Premium covers any enhanced plan benefits offered by MediGold above and beyond the standard PDP benefits. This can include additional coverage in the gap, lower co-payments and coverage of non-Part D drugs. The Part D Total Premium is $0 . The Part D Total Premium is the addition of the supplemental and basic premiums for some plans this amount can be lower due to negative basic or supplemental premiums.
MediGold Gap Coverage
In 2021 once you and your plan provider have spent $4130 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA 'donut hole') You will be required to pay 25% for prescription drugs unless your plan offers additional coverage. This MediGold plan does offer additional coverage through the gap.
H3668-019 Formulary or Drug Coverage
MediGold Essential Care (HMO) formulary is divided into tiers or levels of coverage based on usage and according to the medication costs. Each tier will have a defined copay that you must pay to receive the drug. Drugs in lower tiers will usually cost less than those in higher tiers.By reviewing different Medicare Drug formularies, you can pick a Medicare Advantage plan that covers your medications. Additionally, you can choose a plan that has your drugs listed at a lower price.
2021 MediGold Essential Care (HMO) Summary of Benefits
|Diagnostic services||Not covered|
|Non-routine services||Not covered|
|Prosthodontics, other oral/maxillofacial surgery, other services||Not covered|
|Restorative services||Not covered|
Diagnostic Tests and Procedures
|Diagnostic radiology services (e.g., MRI)||$175 copay|
|Diagnostic tests and procedures||$0-50 copay|
|Lab services||$10 copay|
|Outpatient x-rays||$50 copay|
|Primary||$10 copay per visit|
|Specialist||$50 copay per visit|
Emergency care/Urgent Care
|Emergency||$90 copay per visit (always covered)|
|Urgent care||$50 copay per visit (always covered)|
Foot Care (podiatry services)
|Foot exams and treatment||$50 copay|
|Routine foot care||Not covered|
|Hearing aids||$699-999 copay|
|Hearing exam||$50 copay|
Inpatient Hospital Coverage
|$325 per day for days 1 through 5|
$0 per day for days 6 through 90
|Diabetes supplies||$0 copay per item|
|Durable medical equipment (e.g., wheelchairs, oxygen)||20% coinsurance per item|
|Prosthetics (e.g., braces, artificial limbs)||20% coinsurance per item|
Essential Staff Care Payer Id
Medicare Part B Drugs
|Other Part B drugs||20% coinsurance|
Mental Health Services
|Inpatient hospital - psychiatric||$225 per day for days 1 through 7|
$0 per day for days 8 through 90
|Outpatient group therapy visit||$40 copay|
|Outpatient group therapy visit with a psychiatrist||$40 copay|
|Outpatient individual therapy visit||$40 copay|
|Outpatient individual therapy visit with a psychiatrist||$40 copay|
Optional supplemental benefits
Outpatient Hospital Coverage
|$50-275 copay per visit|
|Dental x-ray(s)||$0 copay|
|Fluoride treatment||$0 copay|
|Oral exam||$0 copay|
|Occupational therapy visit||$40 copay|
|Physical therapy and speech and language therapy visit||$40 copay|
Skilled Nursing Facility
|$0 per day for days 1 through 20|
$184 per day for days 21 through 53
$0 per day for days 54 through 100
|Contact lenses||Not covered|
|Eyeglass frames||Not covered|
|Eyeglass lenses||Not covered|
|Eyeglasses (frames and lenses)||Not covered|
|Routine eye exam||$0 copay|
Wellness Programs (e.g. fitness nursing hotline)
Reviews for MediGold Essential Care (HMO) H3668
|2019 Overall Rating|
|Part C Summary Rating|
|Part D Summary Rating|
|Staying Healthy: Screenings, Tests, Vaccines|
|Managing Chronic (Long Term) Conditions|
|Member Experience with Health Plan|
|Complaints and Changes in Plans Performance|
|Health Plan Customer Service|
|Drug Plan Customer Service|
|Complaints and Changes in the Drug Plan|
|Member Experience with the Drug Plan|
|Drug Safety and Accuracy of Drug Pricing|
Staying Healthy, Screening, Testing, & Vaccines
Essential Staffcare Copay Assistance
|Total Preventative Rating|
|Breast Cancer Screening|
|Colorectal Cancer Screening|
|Annual Flu Vaccine|
|Improving Mental Health|
|Monitoring Physical Activity|
|Adult BMI Assessment|
Managing Chronic And Long Term Care for Older Adults
|SNP Care Management|
|Functional Status Assessment|
|Diabetes Care - Eye Exam|
|Diabetes Care - Kidney Disease|
|Diabetes Care - Blood Sugar|
|Reducing Risk of Falling|
|Improving Bladder Control|
Member Experience with Health Plan
|Total Experience Rating|
|Getting Needed Care|
|Health Care Quality|
|Rating of Health Plan|
Member Complaints and Changes in MediGold Essential Care (HMO) Plans Performance
|Complaints about Health Plan|
|Members Leaving the Plan|
|Health Plan Quality Improvement|
|Timely Decisions About Appeals|
Health Plan Customer Service Rating for MediGold Essential Care (HMO)
|Total Customer Service Rating|
|Reviewing Appeals Decisions|
|Call Center, TTY, Foreign Language|
MediGold Essential Care (HMO) Drug Plan Customer Service Ratings
|Call Center, TTY, Foreign Language|
Ratings For Member Complaints and Changes in the Drug Plans Performance
|Complaints about the Drug Plan|
|Members Choosing to Leave the Plan|
|Drug Plan Quality Improvement|
Member Experience with the Drug Plan
|Rating of Drug Plan|
|Getting Needed Prescription Drugs|
Drug Safety and Accuracy of Drug Pricing
|MPF Price Accuracy|
|Drug Adherence for Diabetes Medications|
|Drug Adherence for Hypertension (RAS antagonists)|
|Drug Adherence for Cholesterol (Statins)|
|MTM Program Completion Rate for CMR|
|Statin with Diabetes|
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Sun 9am-6pm EST
Essential Staffcare Copay Program
Coverage Area for MediGold Essential Care (HMO)
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Data as of September 9, 2020.
Notes: Data are subject to change as contracts are finalized. For 2021, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part D benefit.Includes 2021 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.
When it comes to paying for health care, we’re not all equal. Every person has different circumstances but at the end of the day, we all have healthcare needs.
This is where introducing a Sliding Fee Scale for your medical practice comes into play. This payment system makes it easier for patients to pay their medical bills and can ultimately help your practice’s bottom line.
What is a Sliding Fee Scale?
A sliding fee scale is a payment model providers can use to care for patients who cannot afford care otherwise, for example, those with low-income or who need to self-pay. It allows patients to be able to afford your services and thus make the payments.
It takes time to create, set up and get a sliding fee scale up and running. Let’s go through the steps to follow to get one set up for your practice.
Determine the Cost of Running Your Practice
You likely already know how much it takes to run your practice, but maybe not. Either way, the first step is to get a firm handle on your exact operating costs.
Add up expenses
First things first. Make a list of all the expenses it takes to run your medical practice for a year. Include all the costs, even those you don’t normally think about. Make sure the hard and soft costs are included such as insurance, lease payments, interest on loans, employee salaries, as well as office supplies and medical supplies.
Set your Salary
Next, determine what you want your take-home salary will be. Add that to the expenses above.
Plan Your Sliding Fee Scale
Once you have a solid idea of how much it will take to run your practice for a year, you can focus on creating a sliding scale. Be sure to take time in the planning stage to ensure solid numbers before moving on.
Determine Typical Fees for Your Area
You’ll need to determine the customary fees for health services in your area. These numbers can largely vary for different parts of the country so you must do your research.
Decide on Your Minimum Monthly Income
Once you’ve determined your expenses for one year, divide that number by 12 to determine how much income you need each month.
Use Past Numbers to Determine Patients Per Month
Look back at previous records to figure out how many patients you’ve seen over the past year. Divide that number by 12 to determine your average patients per month.
Set Minimum Fees You Can Charge
Next, divide the monthly minimum income by your average clients per month to determine the minimum fee you can charge.
This step needs to be done for each service you offer and can get tedious. However, putting the time in at the beginning of the process will pay off as you go.
Create Your Sliding Fee Scale
Once the plan is complete, create the actual sliding scale you will use.
Use Federal Poverty Limits
Use the U.S. Federal Poverty Guidelines to determine the fees to charge based on the patient’s income and your predetermined minimum and maximum fees.
Patients who are at or below 100% of the Federal Poverty Level (FPL) will pay the minimum fee while those above that limit will pay incrementally more until reaching the maximum fee you set.
Create the Written Policy and Application
Next, you’ll need to develop the written policy to explain your sliding fee scale. Make the document easy to read and understand by using bolding, bullet points as needed and short, concise sentences. By making the document easy to read, you’ll lessen the risk of patients claiming they didn’t understand because the paperwork was confusing.
The policy needs to include information about the following:
- How to qualify
- How to re-certify
- Documentation needed to qualify (insurance, proof of income, family/household size, residency, etc)
- Fee schedule
Once the policy is written, you’ll need an application for patients to fill out once they determine they are eligible for your sliding fee scale.
The application process needs to be as efficient as possible to ensure the administrative costs do not hinder the helpfulness of the sliding fee scale.
Establish a Policy for Patients with Insurance
Even though a patient may have insurance, they may still need assistance paying their medical bill. You’ll want to address this in your fee policy.
For patients with insurance, the maximum amount an eligible patient in a particular pay class can pay regardless of insurance status should be charged.
For instance, an insured patient receives a treatment for which a maximum fee of $150 applies. Based on this patient’s insurance plan, their copay would be $90. Based on their application for your sliding fee scale, its determined they would be at 150 percent of the Federal Poverty Guidelines and would pay $70 based on your sliding fee schedule. For this patient, rather than paying their typical $90 copay, they would pay the $70 from your fee schedule, as long as there are no insurance contract issues or other legal concerns.
Be sure to consult your third-party payers and/or private legal counsel to be certain discounting patients out of pocket costs is permissible according to the contracts in place.
Once you have a solid policy in place, it is important to be consistent in your offerings.
Spread the Word
Now that the planning and creation of your sliding fee schedule is complete, it’s time to spread the word! How will you let your patients know? Will you post it to your Facebook page? Pin a tweet? Post it on your website? Hang a sign in your office? Perhaps do all of these things!
Assess and Update as Needed
As with all new policies, it’s imperative to take time to get feedback and assess how your sliding fee schedule is doing for your patients as well as your bottom line. You may find you need to tinker with the numbers as you go, but be sure to keep an eye on how it’s working for you.
At the end of the day, creating and implementing a sliding fee schedule can help you serve your patients and help maintain a strong financial base for your practice.
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