A Medicare Nugget, December 1, 2020
(from Stan Cohen for The Bridgton News) — The Medicare monthly premiums for 2021 have been announced. The basic Part B premium will be $148.50 (up $3.90). For those whose annual income was $88,000 ($176,000 for a couple) or more, there is a five-tier range of income levels with premium add-ons for each tier. The highest monthly premium next year (for individuals with 2019 income exceeding $500,000) will be $504.90.
There is a “hold harmless” rule that applies to any increase in the Part B premium. It cannot exceed the dollar amount of any cost-of-living increase in Social Security (SSA) payments. The SSA benefit is going up 1.3% in January. For most beneficiaries, the Part B increase will not exceed the SSA individual increase for 2021.
The Part B annual deductible is also going up, from $198 to $203. The Part A deductible – which applies to in-patient hospital stays each benefit period (60 days) – is increasing from $1408 to $1484. For those who are covered by “traditional Medicare” with a Medicare Supplement policy, the Part A and/or Part B deductibles may be covered.
More detail can be found at WWW.CMS.GOV.
A Medicare Nugget, November 3, 2020
(from Stan Cohen for The Bridgton News) — Medicare Part B is the part that covers physician services, outpatient services, lab tests, surgery, durable medical equipment, X-rays and other health services. The Part B monthly premium is $144.60 in 2020 (somewhat higher for beneficiaries whose annual income exceeds $87,000). Some folks do not sign up for Medicare Part B when they are first eligible because they are covered by group insurance through an employer or union or fraternal organization or are covered by their spouse’s insurance. These seniors have a special enrollment period [SEP] when they can sign up for Part B:
1. Anytime while they are working and still covered by the group health plan or
2. During the 8 month period that begins the day after they retire or the group health plan ends - whichever happens first.
If they sign up during this SEP there is generally no late enrollment penalty. Note: this SEP does NOT apply if they have COBRA coverage or have been on a retiree health plan for more than 8 months.
Here’s the “rub.” Those who do not sign up for Part B during their SEP can enroll only between January 1 and March 31 of any subsequent year. Furthermore, their Part B will not be effective until the following July 1 - and they may have to pay a higher premium for late enrollment. That penalty is computed at 10% for each full year that the beneficiary could have had Part B but was not enrolled.
A Medicare Nugget, October 3, 2020
(from Stan Cohen for The Bridgton News) — Open enrollment for Medicare Part D (prescription drug coverage) begins October 15 and ends December 7. In 2006, when Part D was introduced, we had expected the 16 insurance companies that offered these plans in Maine to present a standard co-insurance amount (25%). In other words, we knew that the premiums would vary among the plans, and that some plans would include a deductible while other would not. What we got was a whole parcel of plans (more than 30) with different sets of co-pays ranged among four tiers of drugs. It would be an understatement to say that those early days of Part D created a good deal of anxiety among seniors who were trying to figure out which Part D Plan would best fit their needs.
The large array of Part D plans has continued to be a source of confusion for many seniors. Not one of the current Part D plans available in Maine has conformed to the original concept of a 25% co-pay across-the-board. That is why I have continued to urge Medicare beneficiaries to use the online Medicare Plan-Finder, or to get help from a Medicare volunteer to do that for them. Studies show that many enrollees simply choose the plan with the lowest premium. That method does not necessarily lead to a plan that is the right one for the beneficiary.
For 2021 there will be 28 Part D plans available in Maine. The monthly premiums range from $7.10 to $99.40. Most plans have a deductible (maximum $445); four plans do not. One of the most popular plans for 2020 was the Envision plan – it has been renamed for 2021 to “Elixer Plus.” Those who have the Envision plan this year will be receiving the change notice from Elixer.
A Medicare Nugget, December 6, 2019
(from Stan Cohen for The Bridgton News) — If you are a military veteran and are Medicare eligible, you can have both Medicare and veterans’ benefits. Medicare, however, does not pay for any care provided at a V.A. facility. You should enroll in Medicare Part A and Part B to guarantee coverage outside the V.A. system.
Many veterans use their V.A. health benefits to get coverage for services not covered by Medicare. For example, some veterans use the V.A. to obtain hearing aid services. Some obtain prescription drugs from the V.A. that may be excluded or too expensive under Medicare Part D or Medicare Advantage. They then rely on Medicare for their other prescriptions and medical care.
V.A. drug coverage is more comprehensive than Medicare’s, and while there are co-pays, there are no premiums or deductibles. The current co-pay for V.A. prescriptions is $11 per 30-day supply. By the way, if you are getting V.A. drug coverage and enroll in Medicare Part D later than when you were first eligible, you will not have to pay a Part D premium penalty. That is because V.A. drug coverage is considered as good (called creditable coverage) as the Medicare drug benefit.
To apply for V.A. benefits call 877-222-8387 or apply online at www.va.gov/health.
A Medicare Nugget, November 13, 2019
(from Stan Cohen for The Bridgton News) — First, a reminder that Medicare Annual Open enrollment ends on December 7. If you have a Medicare Prescription Drug plan (Part D) or a Medicare Advantage plan (Part C) and want to make a change for 2020, you have until that date to get it done. If you happen to be a Maine senior who is currently enrolled in the Part D plan called Humana Walmart Rx drug plan, I want to alert you to a potential problem. If you choose to stay with that plan for 2020 and you do nothing, Humana will automatically keep you in that plan for 2020. Your current monthly premium is $28.60. If you stay in that plan your premium will go up to $57.30 on January 1. That amounts to a 100% increase! Humana has changed the name of your current plan to Humana Premier plan for 2020. Same Medicare contract number (S5884-148) — new name — new premium. If you want to stay with a Humana plan with a low premium ($13.20), you will need to switch to the Humana Walmart Value plan (S5884-181) and do that by December 7.
A Medicare Nugget, October 4, 2019
(from Stan Cohen for The Bridgton News) — Next year seniors in many states will be able to get additional Medicare services, such as help with chores, safety devices, and respite for caregivers, through private "Medicare Advantage" insurance plans. The services will be offered by some Medicare Advantage plans in about 20 states and expected to grow over time. For years, Medicare has permitted private plans to offer additional benefits not covered by “Traditional Medicare.” Think free gym memberships, transportation to medical appointments, or home-delivered meals following a hospitalization. The expanded benefits reflect a growing recognition that simple help at home can have a meaningful impact on a patient’s well-being.
Nearly 23 million Medicare beneficiaries, or more than 1 in 3, are expected to be covered by a Medicare Advantage plan next year. The private plans generally offer lower out-of-pocket costs in exchange for limits on choice of doctors and hospitals and other restrictions such as prior authorization for services. Also, these plans tend to have high co-pays for hospitalization compared to the Part A deductible in Traditional Medicare. Medicare Advantage open enrollment begins October 15 and ends December 7.
By the way – to end this Nugget with an “upbeat”: the infamous “donut hole” or gap in Medicare prescription drug coverage (Part D) ends Dec. 31 this year. Open enrollment for Part D is the same as for Medicare Advantage [it begins October 15]. Whether or not you switch to a different Part D plan for next year, or stay with the one you have, there will be no donut hole. The usual co-pays (25% on average) will apply.
A Medicare Nugget, September 1, 2019
(from Stan Cohen for The Bridgton News) — One of the benefits of the Affordable Care Act for Medicare beneficiaries is a free, annual wellness visit to your physician. This is NOT an annual physical exam. It does, however, include several services that a doctor often includes in an annual physical. The annual wellness visit:
• Conducts, if you wish, advance care planning (e.g. Advance Directives)
• Establishes a list of risk factors and conditions
• Personalizes health advice and, if needed, referral
Be sure to let your doctor’s office know, when you make the appointment, that it is for a Medicare Annual Wellness visit. There is no co-pay.
Need help? Get some unbiased advice by calling SeniorsPlus at 1-800-427-1241.
A Medicare Nugget, August 1, 2019
(from Stan Cohen for The Bridgton News) — Durable medical equipment like walkers, wheelchairs, power scooters, hospital beds, diabetes self-testing equipment, home oxygen equipment, and certain nebulizers, are covered under Medicare Part B. The usual co-pays apply unless they are covered by a Medicare Supplement plan. To be covered, however, they must be provided by a Medicare approved supplier.
In most cases, items used for convenience rather than medical necessity aren’t covered under Medicare. Also not covered are medical supplies, such as catheters, that are disposable and thrown away after use. An exception to this rule is that Part B does cover lancets and test strips for diabetes. Another exception is that if you qualify for Medicare-covered home health care, certain disposable items, such as intravenous supplies, gauze, or catheters may be covered.
Need help? Get some unbiased advice by calling SeniorsPlus at 1-800-427-1241.
August Monthly Medicare Message
Supplement Plan Changes
From time to time Medicare changes the rules about Medicare Supplement plans and a new plan may be added – or a current one removed. That will happen on January 1st, 2020.
Only two Medicare Supplement plans, C & F, currently cover the Medicare Part B, annual deductible ($183 this year). The government has declared that after December 31, 2019, Supplement plans that offer Part B deductible coverage will no longer be offered. Apparently, this is an attempt to drive more people to have a greater financial stake in their own health (they call it “having more skin in the game”).
The good news is that Medicare beneficiaries who have, or are eligible to have, Plan C or F up to that date, will continue to be eligible for it. For new Medicare beneficiaries after that date, Supplement plan G will then be the plan with the most comprehensive benefits. A new “High Deductible” plan G will also be phased in.
Medicare questions? Need help? Call SeniorsPlus at 1-800-427-1241.
June Monthly Medicare Message
Special Enrollment Period
The Medicare Advantage Disenrollment Period ended in mid-February. If you missed the deadline, you might be able to change your coverage if you meet the requirements for a Special Enrollment Period [SEP]. There are several reasons that you might qualify for a SEP to disenroll from your Medicare Advantage Plan and enroll in different coverage. For example, people who have Medicaid or the Medicare Savings Program have the option to join, disenroll from, or switch Plans (including Part D drug plans) once every month - although I would not encourage doing it that frequently. You may also have an SEP if you move, if your Medicare Advantage Plan stops contracting with many of its providers, or if you want to enroll in a plan that has a 5-star rating.
Also, if you initially joined your plan because you were misled in some way, you could be entitled to a SEP to change coverage. This is an option if you think you experienced misleading marketing, or if you were enrolled in your plan without your consent.
If you do make a change, make sure that with the new coverage you choose you will be able to see your usual doctors and continue to have your medications covered. If you are not sure, get some unbiased advice by calling 1-800-427-1241.
May Monthly Medicare Message
Getting a second opinion
A “second opinion” is when you ask a doctor, other than your regular doctor, for her view on symptoms, an injury, or an illness you are experiencing in order to better help you make an informed decision about treatment options. Medicare covers second opinions if your doctor recommends that you have surgery or a major diagnostic or therapeutic procedure. Note: Medicare does not cover second opinions for excluded services such as cosmetic surgery.
Medicare will also cover a third opinion if the first and second opinions are different from each other. The second and third opinions will be covered even if Medicare will not ultimately cover your procedure (unless it is an excluded service).If the first and second opinions were the same, but you want a third opinion, you may be able to see a third doctor for a confirmatory consultation. Medicare may cover a confirmatory consultation if your doctor submits the claim correctly and the services are reasonable and necessary (even if Medicare will not ultimately cover them).
April Monthly Medicare Message
New Medicare cards are coming!
You will receive a new card sometime in 2018 or 2019. It will have a new number. You don't need to do anything as long as your address (at the Social Security Administration) is up to date.
Avoid Scams: Medicare will NOT call you about it. It will NOT cost you anything. Don’t give out personal information over the phone. Destroy your old card when the new one arrives. Call SeniorsPlus at 207-795-4010 if you have any questions.
March Monthly Medicare Message
Prescription drug safety
Prescription drugs play an important role in treating many conditions and diseases, but when no longer needed they are not safe to keep in your home. Proper disposal of medication:
- Keeps you from taking the wrong medicine or an expired one.
- Protects children and pets from poisoning.
- Discourages misuse or abuse of prescription drugs.
Keeping unused prescriptions in your house can be dangerous!
February Monthly Medicare Message
Medicare Advantage Plans
A Medicare Advantage Plan (like an HMO or PPO) is another way to get your Medicare coverage. If you join a Medicare Advantage Plan, you still have Medicare. You’ll get your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage from the Medicare Advantage Plan, not Original Medicare. Most plans include Medicare prescription drug coverage (Part D). Medicare Advantage Plans, sometimes called “Part C” or “MA Plans” are offered by private companies that Medicare approves. Please contact SeniorsPlus at 207-795-4010 if you have any questions about Medicare Advantage Plans.
January Monthly Medicare Message
Medicare-covered preventive services
An easy New Year’s resolution, to make and fulfill, is to schedule your free Medicare Annual Wellness visit. This visit is covered once every 12 months, if you have had Part B for longer than a year.
When you make the appointment, make sure you specify that it is your “yearly wellness visit.” This gives you an opportunity to spend quality time with your primary care physician. It’s a visit to talk about your health and develop a personalized prevention plan.
December Monthly Medicare Message
Medicare Advantage Disenrollment
Medicare Advantage Disenrollment Period is from January 1 to February 14, 2018. You can switch from your Medicare Advantage plan to Original Medicare during the Medicare Advantage Disenrollment Period.
If you have a Medicare Advantage plan you will be able to switch to Original Medicare with or without a stand-alone prescription drug plan. Changes made during this period will become effective the first of the following month. Please contact SeniorsPlus at 207-795-4010 if you have any questions.
A Medicare Nugget, Nov. 15, 2017
(from Stan Cohen for The Bridgton News) — The August Nugget focused on patients who were leaving Medicare Advantage plans because their insurers were, among other obstacles, making access to specialists difficult. This Nugget brings to light a Government Accountability Office report in which Medicare Advantage plans, in 2016, received improper payments amounting to more than $16 billion. That’s right – BILLION! That is just one year out of ten (the Medicare Advantage program began in 2006).
Some of the “improper payments” were caused by billing mistakes. Fraud, on the other hand, played a large part in this drain on our tax dollars. To be fair, Traditional Medicare (as opposed to Medicare Advantage) is also experiencing high rates of improper payments.
The article by Fred Schulte from which this information was drawn appeared in the Kaiser Health News, July 19th edition. It should be noted that there is no evidence in that KHN report that Medicare Advantage plans in Maine are in any way guilty of fraud. Can you help reduce improper payments by Medicare to health providers? Yes, you can. When you receive quarterly reports from Medicare or from your Medicare Advantage plan – look at them carefully to be sure the listed services or devices were, in fact, provided.
November Monthly Medicare Message
Medicare Fraud
Protect your Medicare number from fraud by treating it like a credit card. Don’t ever give out your number, except to your doctor or Medicare provider. Never give your Medicare number in exchange for free medical equipment or any other free offer. Dishonest providers can use your number to get payment for services they never provided.
Please contact SeniorsPlus if you have any questions about Medicare fraud at 1-800-427-1241.
A Medicare Nugget, Oct. 15, 2017
(from Stan Cohen for The Bridgton News) — Medicare Fall Open Enrollment runs from October 15 through December 7 and it’s a time when you can make changes to your Medicare coverage. Here is what you can do during Open Enrollment:
If you need help, trained counselors are available at SeniorsPlus by calling 1-800-427-1241.
October Monthly Medicare Message
Medicare Advantage Plans
A Medicare Advantage Plan (like an HMO or PPO) is another way to get your Medicare coverage. If you join a Medicare Advantage Plan, you still have Medicare. You will get your Medicare A (Hospital Insurance) and Medicare B (Medical Insurance) coverage from the Medicare Advantage Plan, not Original Medicare. Most plans include Medicare prescription drug coverage (Part D). Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by private companies that Medicare approves. Please contact SeniorsPlus at 1-800-427-1241 or 207-795-4010 if you have any questions about Medicare Advantage Plans.
A Medicare Nugget, Sept. 1, 2017
(from Stan Cohen for The Bridgton News) — Although prostate cancer is a relatively common disease, in many cases the cancer does not grow or cause symptoms. If it does, it often grows so slowly that it isn’t likely to cause health problems during a man’s lifetime. Even so, prostate cancer is the second most common cancer in men in the United States, after skin cancer. Two tests are commonly used to screen for prostate cancer: A blood test to check for prostate-specific antigen (PSA) and a digital rectal exam.
To get details on other Medicare preventive services, check out Maine Legal Services for the Elderly website at www.mainelse.org, and type in the search box: “preventive”.
September Monthly Medicare Message
Call us now for an Open Enrollment appointment
October 15th through December 7th is open enrollment for Medicare Parts C & D. Medicare plan benefits and your needs change each year, so this is the time to compare your options and chose the right plan. SeniorsPlus provides unbiased expertise to review your prescription drug plan. There is no fee for this service. Donations are welcome. Please call us at 1-800-427-1241 to schedule an appointment.
August Monthly Medicare Message
Coverage of durable medical equipment
Did you know that Medicare Part B covers medically necessary durable medical equipment (DME) that your doctor prescribes for use in your home. Only your doctor can prescribe medical equipment for you. DME meets these criteria:
• Durable (can withstand repeated use)
• Used for a medical reason
• Not usually useful to someone who isn't sick or injured
• Used in your home
• Has an expected lifetime of at least 3 years
If you have questions about the cost of durable medical equipment or coverage, call 1-800-MEDICARE or SeniorsPlus at 207-795-4010.
A Medicare Nugget, July 31, 2017
(from Stan Cohen for The Bridgton News) — There is some truth to the notion that privately-run Medicare Advantage (MA) plans, which enroll about 30% of all people eligible for Medicare, offer good value. On the other hand, according to an article in Kaiser Health News by Fred Schulte, MA plans can prove risky for seniors in poor or declining health, who need to see specialists. That is because they often face problems getting access.
A Government Accountability Office report, released this spring, reviewed 126 Medicare Advantage plans and found that 35 of them had disproportionately high numbers of sicker people dropping out. Patients cited difficulty with access to “preferred doctors and hospitals” or other medical care, as the leading reasons for leaving.
“People who are sicker are much more likely to leave (Medicare Advantage plans) than people who are healthier,” James Cosgrove, director of the GAO’s health care analysis, said in explaining the research.
The GAO report on Medicare Advantage comes as federal officials are ramping up fines and other penalties against errant health plans. In the first two months of this year, for instance, the Centers for Medicare & Medicaid Services fined 10 Medicare Advantage health plans more than $4.1 million for alleged misconduct that “delayed or denied access” to covered benefits, mostly prescription drugs.
If you are thinking about enrolling in a Medicare Advantage plan this fall, my advice is to first talk with an independent Medicare counselor.
July Monthly Medicare Message
Did you know there are many services Medicare Part A and B do not cover? This means you may have out-of-pocket expenses for deductibles, premiums, co-payments, and more!
These gaps in coverage can be filled in with supplemental coverage such as retiree or employer insurance, a Medigap policy, veterans benefits, Tricare for Life, or a Medicare Savings Program.
To learn more about how to fill in these gaps in coverage, call us at 1-800-427-1241.
A Medicare Nugget, June 29, 2017
(from Stan Cohen for The Bridgton News) — It is important to know whether your hospital overnight stay is designated INPATIENT or OUTPATIENT.
Under traditional Medicare, if you are overnight as an OUTPATIENT, [example: for “observation”] the hospital will bill outpatient services, like radiology and laboratory services, under Medicare Part B. That includes physician’s services even if the physician was not your primary care doctor. You may then owe coinsurance (usually 20% of Medicare’s approved amount for that care). Those co-insurance charges may be covered by your Medicare Supplement insurance, but if you have a Medicare Advantage plan you will need to ask the plan if there will be any co-pays charged to you.
On the other hand, you are an INPATIENT if your attending physician has formally admitted you as an inpatient. While an inpatient, your physician services will be billed under Part B, but the hospital charges will come under Part A. If you are a hospital inpatient, you must first meet the Part A hospital deductible of $1,316. Once you meet the deductible, you pay zero dollars for the first 60 days of inpatient care in each benefit period. You may owe daily hospital charges for stays longer than 60 days. The Part A deductible and long-stay hospital charges may be covered by your Medicare Supplement insurance.
If you don’t know how your hospital stay has been classified (inpatient or outpatient) – ask.
June Monthly Medicare Message
If you are: new to Medicare, currently on Medicare, interested in the Medicare Savings Programs, getting confusing mail about Medicare, need assistance with Medicare Part D drug plan then...
SeniorsPlus, the Aging and Disability Resource Center for Androscoggin, Franklin and Oxford counties, has Medicare Counselors to assist you with your Medicare needs.
Please call us at 207-795-4010 to schedule a free appointment at one of the following Medicare Counseling locations:
Bethel Telstar High School • Fryeburg Library • SeniorsPlus Farmington • Norway Town Office • SeniorsPlus Lewiston
A Medicare Nugget, April 27, 2017
(from Stan Cohen for The Bridgton News) — The Medicare Annual Wellness Visit has often been described as a free physical exam. It is free, but it isn’t a true head-to-toe physical. It is, rather, an annual appointment with your primary care doctor to develop your plan of preventive care for the upcoming year. It is an opportunity to discuss your current health with your doctor and create a plan for promoting your health and wellness. I encourage every Medicare beneficiary to take advantage of this Medicare feature. When you make the appointment, be sure to explain that you want an annual Medicare Wellness Visit.
Medicare covers the Annual Wellness Visit with no coinsurance or deductible as long as you see health care providers who accept Medicare assignment. During your first Annual Wellness Visit, you and your doctor will create a prevention plan based on your needs. Subsequent Annual Wellness Visits will update the plan. Keep in mind that while the Annual Wellness visit itself is free, out-of-pocket costs may or may not apply for additional care you receive during or following the visit.
May Monthly Medicare Message
Do you have limited finances?
Do you have, or are you eligible for Medicare?
If you answered “Yes” to either question, you may qualify for a Medicare Savings Program (MSP), also known as the Medicare Buy-In program. MSP helps pay your Medicare costs and most of your Medicare prescription drug plan costs.
For more information and help applying for the Medicare Savings Programs, call SeniorsPlus at 207-795-4010.
April Monthly Medicare Message
Prescription Medicare Part D (prescription drug coverage) is available to everyone with Medicare. Private companies provide this coverage. You choose the Medicare drug plan and pay a monthly premium. Each plan can vary in cost and specific drugs covered. If you decide not to join a Medicare drug plan when you’re first eligible, and you don’t have other creditable prescription drug coverage, or you don’t get Extra Help, you will likely pay a late enrollment penalty.
For Medicare assistance, please call SeniorsPlus at 207-795-4010.
A Medicare Nugget, February 23, 2017
(from Stan Cohen for The Bridgton News) — One of the ideas that Congress has been considering in its effort to control the costs of Medicare, is to raise the age of eligibility.
The National Committee to Preserve Social Security and Medicare Foundation and the Actuarial Research Corporation (ARC) recently released a new study on the impact of raising the eligibility age for Medicare from 65 to 67.
According to ARC projections, if Medicare eligibility is raised to age 67 and the Affordable Care Act (ACA) remains in effect, by 2019 the percent uninsured among those aged 65 and 66 will increase more than nine-fold, from less than 2% to 18.7% (1.9 million people).
If the ACA is repealed, and that fight is evidently not over, the uninsured rate would then increase to 37%. That is more than one-third of those 65 and 66, affecting 3.8 million seniors.
According to the report, raising the Medicare eligibility age would likely result in people ages 65 and 66 forgoing needed care. As a result, those who forgo care could experience worsening health outcomes and create higher expenses for the Medicare program when they are finally eligible.
It is fair to conclude that raising the Medicare eligibility age would have a profound impact on the health and financial stability of near retirees. It would, in all likelihood, cost taxpayers more in the long term.
For more information or assistance, please call SeniorsPlus at 207-795-4010.
March Monthly Medicare Message
Prescription drugs play an important role in treating many conditions and diseases, but when no longer needed, they are not safe to keep in your home. Proper disposal of medication:
• Keeps you from taking the wrong medicine or an expired one.
• Protects children and pets from poisoning.
• Discourages misuse or abuse of prescription drugs.
Keeping unused prescriptions in your house can be dangerous!
A Medicare Nugget, February 23, 2017
(from Stan Cohen for The Bridgton News) — What is the “Donut Hole” in Medicare Part D?
1. Starting on Jan. 1 Mr. Dill pays the first $400 for his medicines before his plan starts to pay its share. That is his plan’s deductible. Some plans have no deductible.
2. Following the deductible period Mr. Dill pays a co-payment when he buys his medicines (the co-payment may be zero for some generics in some plans). His plan pays the rest. This is called the INITIAL COVERAGE PERIOD.
3. If and when Mr. Dill’s share, plus the amount paid by his plan, reaches a total of $3,700, he enters the coverage gap (the donut hole). In 2017, while in this “gap” period, he will pay 40% of the cost of brand name medicines, and 51% of the cost of generics. Also during this period, the total cost of the drugs he buys counts as out-of-pocket spending which may help him get out of the donut hole.
4. If and when Mr. Dill has spent $4,950 out-of-pocket (counting from Jan. 1 and not including the monthly premium), he will enter the so-called CATASTROPHIC period – and will pay only a small co-payment for each drug until the end of the year. Otherwise, he will continue in the donut hole until the end of the year.
The good news is that, because of a rule in the Affordable Care Act (Obamacare), the Part D coverage gap will vanish in the year 2020.
For more information or assistance, please call SeniorsPlus at 207-795-4010.
February Monthly Medicare Message
If you have Medicare, you’ll get an Explanation of Benefits and/or a Medicare Summary Notice each month for any services, supplies, equipment, or medications you received during that month. Please review it carefully. If you notice any discrepancy, please contact your provider immediately. If, after contacting your provider, you are not satisfied with their response, contact us and we will assign a Medicare Advocate to assist you in resolving the issue.
A Medicare Nugget, January 26, 2017
(from Stan Cohen for The Bridgton News) — One of the unfortunate myths that has been circulating (during the 2016 presidential campaign, and since), is that Medicare is going broke! Medicare is NOT imminently running out of money. That myth has been debunked over and over again, but the forces that want to restructure Medicare into a voucher program keep promoting the fiction in order to support their agenda.
One of the most respected and non-partisan research groups in America is the Center on Budget Policy Priorities (CBPP). It is a non-profit organization funded by grants from foundations, many of which are republican based. The CBPP Trustees write: “Medicare’s Hospital Insurance trust fund (HI) will remain solvent – that is, able to pay 100% of the insurance coverage it provides – through 2028. Even after 2028, when the HI trust fund is projected for depletion, incoming payroll taxes and other revenue will still cover 87% of Medicare hospital insurance costs.” Furthermore, CBPP has identified several solutions to closing the gap after 2028.
Another common myth: The Affordable Care Act (ACA) is causing Medicare to go broke. In fact, the opposite is true. According to CBPP, the ACA and other factors have significantly improved the financial outlook for Medicare. Those of us on Medicare or soon to be on Medicare, therefore, should encourage our federal legislators to back-off their efforts to gut the ACA.
January Monthly Medicare Message
Medicare covered preventive services: An easy New Year’s resolution to make and fulfill is to schedule your free Medicare Annual Wellness visit. This visit is covered once every 12 months if you have had Part B for longer than a year.
When you make the appointment, make sure you specify that it is your “yearly wellness visit.” This gives you an opportunity to spend quality time with your primary care physician. It’s a visit to talk about your health and develop a personalized prevention plan.
A Medicare Nugget, December 29, 2016
(from Stan Cohen for The Bridgton News) — Would you like to look up your own history of Medicare claims and payments? You can do that and you can also view the following information about your Medicare preventive services:
• “Two-Year Calendar of Current and Upcoming Preventive Services,” which show the services for which you are eligible in the current and following year.
• “You are Eligible for These Services Now,” which list all preventive services available to you immediately.
It isn’t difficult to get started. You need only set up, online, a personal, private account with Medicare. If you don’t have a computer of your own, most town libraries offer the use of computers and assistance in using them.
Begin by logging on to www.MyMedicare.gov and click “create an account.” Then register with a user name and password. This is a great way to make sure that all health-related charges made on your behalf to Medicare are, in fact, accurate. It also serves as a reminder of which preventive services you should consider asking your doctor about -- and it’s free.
Medicare questions? Need help? Call 1-800-427-1241.
December Monthly Medicare Message
You can switch from your Medicare Advantage plan to Original Medicare during the Medicare Advantage Disenrollment Period, January 1 to February 14, 2017.
If you have a Medicare Advantage plan you will be able to switch to Original Medicare with or without a stand-alone prescription drug plan. Changes made during this period will become effective the first of the following month. Please contact us at 1-800-427-1241 or 207-795-4010 if you have any questions.
A Medicare Nugget, November 28, 2016
(from Stan Cohen for The Bridgton News) — The basic Medicare Part B premium will increase 10% in 2017, but about 70% of Medicare beneficiaries will see only a relatively small increase in their Part B premium – from $104.90 to about $109. That is because the law contains a “hold harmless” provision that limits the dollar increase in the Part B premium to the dollar increase in an individual’s Social Security benefit.
But what’s going to happen to the 30 percent of beneficiaries not protected by the hold harmless provision? These include new enrollees during the year 2017; enrollees who do not receive a Social Security benefit; enrollees with high incomes (they are subject to the income-related premium adjustment); and dual Medicare-Medicaid beneficiaries, whose full premiums are paid by state Medicaid programs. Many in these categories will pay the new premium of $134.00 – up from $121.80 in 2016. On the other hand, those who first claimed Social Security benefits in 2016 and are paying $121.80 now, won’t pay more in 2017 than $134, or $121.80 plus the dollar increase in Social Security benefits they receive in 2017 (whichever is less).
Reminder: The open enrollment period for Medicare Part D and Medicare Advantage plans ends on December 7th.
Disclosure: Some of the text in this Nugget was borrowed from an article by Alicia H. Munnell, published in Market Watch.
What is a Medigap policy?
The Medicare Rights Center answers this question: "I am turning 65 soon and am confused about supplemental health insurance. I see so much advertising about these plans, but what are they and do I need one?"
Visit www.medicarerights.org/resources/newsletters/dear-marci for the answer.
November Monthly Medicare Message
Medicare fraud: Protect your Medicare number and Social Security number from fraud by treating them like they are credit cards. Don’t ever give them out except to your doctor or Medicare provider. Never give your Medicare number in exchange for free medical equipment or any other free offer. Dishonest providers can use your numbers to get payment for services they never provided.
Please contact SeniorsPlus if you have any questions about Medicare fraud at 1-800-427-1241.
October Monthly Medicare Message
Medicare Open Enrollment is held from October 15th through December 7th for Medicare Parts C & D.
Medicare plan benefits and your needs change every year, so this is your opportunity to compare your options and get the right plan for you. SeniorsPlus provides unbiased expertise to review your current prescription drug plan. There is no charge for this service. Donations are appreciated.
An appointment is need to ensure we have time to meet with you. Call us at 1-800-427–1241 to schedule one.
September Monthly Medicare Message
A Medicare Advantage Plan (like an HMO or PPO) is another way to get your Medicare coverage.
If you join a Medicare Advantage Plan, you still have Medicare. You’ll get your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage from the Medicare Advantage Plan, not Original Medicare. Most plans include Medicare prescription drug coverage (Part D). Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by private companies that Medicare approves.
Please contact SeniorsPlus at 207-795-4010 if you have any questions about Medicare Advantage Plans.
A Medicare Nugget, August 24, 2016
(from Stan Cohen for The Bridgton News) — According to Susan Jaffe, a writer for Kaiser Health News, “With Medicare’s specific approval, a health insurance company can automatically enroll a member of its marketplace or other commercial plan into its Medicare Advantage coverage when that individual becomes eligible for Medicare.” The insurance industry calls that called “seamless conversion.” I call it abusive corporate behavior even though it is legal.
Some seniors would choose traditional Medicare coverage rather than Medicare Advantage (or a different Medicare Advantage plan) if they knew they had choices. This exploitative auto-enroll practice should, in my opinion, be outlawed by the Center for Medicare and Medicaid Services.
August Monthly Medicare Message
If you have Original Medicare, your doctor, other health care provider, or supplier may give you a notice called an Advance Beneficiary Notice of Non-coverage (ABN). This notice says Medicare probably will not pay for some services in certain situations.
All doctors must use the Medicare approved ABN, which provides you with an estimate of the cost of the treatment if Medicare does not pay for it. This notice gives you the option to choose whether or not you want your claim submitted to Medicare. It is wise to have your doctor submit the claim to Medicare, as Medicare may pay for the services or items. Please call us at 207-795-4010 if you have any questions.
A Medicare Nugget, August 1, 2016
(from Stan Cohen for The Bridgton News) — There are several programs available to assist low-income seniors with health coverage. Examples: MaineCare, Medicare Savings Program, Low Cost Drugs for the Elderly, Maine Rx Plus, Federal Low Income Subsidy for Part D, and pharmaceutical company Patient Assistance Programs. Even many hospitals have “free care” policies for those who are really needy.
I suspect that one reason why many eligible seniors do not enroll in these programs is that Mainers are proud, self-reliant people. These are admirable qualities. In most cases, however, an eligible person has already helped to pay for the assistance program through income taxes. It is, therefore, not a “hand-out”. They should, in my view, not let pride get in the way of taking care of themselves.
Think of it this way. The healthier you can stay, the less you become a burden to yourself, your family, and to your community. So, in a very real way, each eligible person who applies for assistance from one or more of these public programs is doing everyone a favor.
A Medicare Nugget, July 14, 2016
(from Stan Cohen for The Bridgton News) — The Trustees of the Medicare Trust Fund, the fund that finances Medicare’s hospital insurance coverage, projected in June that Medicare Part A will remain fully funded until 2028, 11 years longer than they projected in 2009 but slightly shorter than projected a year ago.
“Cost growth per beneficiary continues to be exceptionally low,” said Andy Slavitt of the Centers for Medicare & Medicaid Services, “and over the next decade, per-enrollee Medicare spending growth is expected to continue to be lower than the growth in overall per capita national health expenditures.” That’s the good news.
But not all is rosy. The Medicare Trustees noted that the growth in the costs of prescription drugs paid by Medicare continue to exceed growth in other Medicare costs. MedPAC, the congressional agency charged with making regular recommendations on Medicare, said spending for Medicare's prescription program (Part D) grew by nearly 60 percent from 2007 through 2014, from $46 billion to $73 billion. That is unsustainable. One measure that could mitigate this seemingly out-of-control spending on drugs is to give the administration the authority to negotiate drug pricing for Medicare Part D. Just like the V.A. does. A similar plan has been submitted to Congress more than once – and has been defeated each time. Guess who is doing the lobbying.
A Medicare Nugget, July 7, 2016
(from Stan Cohen for The Bridgton News) — Remember the “doc fix” crises? For several years congress made annual, temporary adjustments to the way Medicare paid doctors so that payments to physicians wouldn’t fall of the proverbial cliff. Then came the Medicare Access and CHIP Reauthorization Act of 2015 which essentially ended the year-to-year problem. That legislation also made numerous improvements to our health care system, including payments based on value rather than on volume.
The way Medicare currently measures the quality of care provided by clinicians depends on which of six “Alternative Payment Models” they are participating in. These various programs will now be integrated into a single framework to help doctors transition from payments based on volume to payments based on value. “It will improve the relevancy and depth of Medicare’s quality-based payments and increase clinician flexibility by allowing clinicians to choose measures and activities appropriate to the type of care they provide”. We’re getting there – be patient.
A Medicare Nugget, July 5, 2016
(from Stan Cohen for The Bridgton News) — Remember the infamous “doughnut hole” in Medicare Part D? Well, it is going to be with us for three and a half more years. This coverage gap kicks-in when drug purchases under Medicare Part D (computed from January 1) reach a certain dollar level. This year, that level is $3310 and includes both the buyer’s co-pays and the contributions from the plan. The good news is that, because of provisions in the 2010 Affordable Care Act, big discounts apply to drugs bought during the coverage gap. And these discounts increase each year:
Year
Brand name drugs Generic drugs
2016 55%
42%
2017 60%
49%
2018 65%
56%
2019 70%
63%
2020 No more “doughnut hole”
Medicare Volunteer Counselors are available for one-on-one consultations at no charge.
July Monthly Medicare Message
Durable Medical Equipment: Did you know that Medicare Part B covers durable medical equipment (DME) that your doctor prescribes for use in your home?
• Anyone with Medicare Part B is eligible.
• Generally, you pay 20% of the Medicare-approved amount after you have
met your Part B deductible for the year. The amount you pay may vary
depending on the kind of DME needed.
If you have questions about the cost of durable medical equipment or coverage, call 1-800-MEDICARE or call SeniorsPlus at 1-800-427-1241.
A Medicare Nugget, June 28, 2016
(from Stan Cohen for The Bridgton News) — A program that has helped seniors understand the many intricacies of Medicare as well as save them millions of dollars, would be eliminated by a budget bill approved in June by the powerful Senate Appropriations Committee. The program is called the State Health Insurance Assistance Program, or SHIP.
Sen. Roy Blunt, R-Mo., chairman of the appropriation committee’s health and labor subcommittee, said in a statement last week: “Cutting these ‘unnecessary federal programs’ helped provide needed funding for other efforts”. How he can call the SHIP program unnecessary is beyond my comprehension. SHIP counselors are in every state, the District of Columbia and the U.S. territories offering free advice on how to choose from an array of drug and health insurance plans, challenge coverage denials, and receive financial subsidies for premiums, co-payments and deductibles. They provide one-on-one counseling as well as host enrollment clinics, informational meetings, special “Welcome to Medicare” events for new beneficiaries and answer questions over toll-free telephone help lines. Local SHIP programs cannot survive without federal support.
Howard Bedlin, vice president at the National Council on Aging said: “Last year SHIPs helped 7 million people navigate this program and without those services, people will not be able to make well-informed choices. That’s going to cost them money.”
I am a SHIP counselor and have been privileged to have helped hundreds of Maine seniors figure out the intricacies of Medicare. Ask them if the SHIP program is worthwhile.
Medicare Volunteer Counselors are available for one-on-one consultations at no charge.
Medicare services for elderly, low-income, and adults with disabilities
If you are low-income or a working person with a disability, you could benefit from a Medicare Savings Program.
Monthly allowed income limits are higher in Maine than the national guidelines. Call SeniorsPlus to see if you are eligible for assistance -- 207-795-4010 or 1-800-427-1241.
June Monthly Medicare Message
Gaps in Medicare coverage: Did you know there are many services Medicare Part A and B do not cover?
This means you may have out-of-pocket expenses for deductibles, premiums, co-payments, and more! These gaps in coverage can be filled in with supplemental coverage such as retiree or employer insurance, a Medigap policy, Veterans benefits, Tricare for Life, or a Medicare Savings Program.
To learn more about how to fill in these gaps in coverage, call us at 1-800-427-1241.
A Medicare Nugget, May 19, 2016
(from Stan Cohen for The Bridgton News) — I’d like to think that our government is ready and willing to make sure that we, the people, are not victims of greed by large corporations. Yet some private Medicare Advantage plan insurers, who cover medical treatment for the elderly, have overbilled the government by billions of dollars and they get away with it! According to a congressional audit released early in May, these plans “have rarely been forced to repay the money or face other consequences for their actions.” The audit was conducted by the Government Accountability Office (GAO) and reported by the Center for Public Integrity, a nonpartisan, nonprofit.
The GAO called for "fundamental improvements" to curb overbilling by the health plans, which are paid more than $160 billion annually. “While Medicare officials have quietly conducted audits since 2008, they have never imposed stiff financial penalties, even as evidence built-up that billing errors were deeply rooted and wasting tax dollars at an alarming clip.”
May Monthly Medicare Message
Do you have limited finances?
Do you have, or are you eligible for Medicare?
If you answered “Yes” to either question you may qualify for a Medicare Savings Program (MSP), also known as the Medicare Buy-In program. MSP helps pay your Medicare costs and most of your Medicare prescription drug plan costs.
For more information and help applying for the Medicare Savings Programs call SeniorsPlus at 800-427-1241.
A Medicare Nugget, April 29, 2016
(from Stan Cohen for The Bridgton News) — An Explanation of Benefits (EOB) is a notice that your Medicare Advantage Plan (or Part D plan) sends you after you receive health care services.
As the Medicare Rights Center points out, the EOB is important because, among other things, if your Medicare Advantage insurer has denied coverage for a service you received, the EOB allows you to begin an appeal. An appeal is when you ask your plan to reconsider its decision to deny coverage. First look for footnotes on the EOB that explain why the service was denied. This will be useful in writing your appeal.
There should be instructions about how to appeal included on the last page of your EOB, and you will need to start your appeal within 60 days of the date of the notice. If possible, it is a good idea to ask your provider (usually your doctor) to help with the appeal by including relevant medical records and a letter of support.
Medicare Volunteer Counselors are available for one-on-one consultations at no charge.
April Monthly Medicare Message
Medicare prescription drug coverage (Part D) is available to everyone with Medicare. Private companies provide this coverage. You choose the Medicare drug plan and pay a monthly premium. Each plan can vary in cost and specific drugs covered. If you decide not to join a Medicare drug plan when you’re first eligible, and you don’t have other creditable prescription drug coverage, or you don’t get Extra Help, you will likely pay a late enrollment penalty.
A Medicare Nugget, April 1, 2016
(from Stan Cohen for The Bridgton News) — It is true that Medicare does not generally pay for eye care or eyeglasses, but it will cover cataract surgery under Part B. That means you will be responsible for a co-pay if you do not have a Medicare supplement plan. If you have a Medicare Advantage Plan, contact them before hand to learn about how the plan covers cataract surgery.
Here is what is specifically covered: The removal of the cataracts; basic lens implants; and one set of prescription eyeglasses or contact lenses after the surgery. The glasses would be a basic style – no bells and whistles. You may have a problem having Medicare pay for part of the cost of the specs if you get them from a supplier that does not accept “assignment” from Medicare. About the lens implants: If your provider recommends more advanced implants, you may have to pay some or all of the cost.
March Monthly Medicare Message
Senior Medicare Patrol (SMP) is a government program created in 1995 to help Medicare beneficiaries fight fraud, errors, and abuse of the Medicare and Medicaid programs.
If you have questions, or think you have been a victim of Identity Theft or Medicare Fraud, contact SeniorsPlus at 1-800-427-1241.
A Medicare Nugget, February 22, 2016
(from Stan Cohen for The Bridgton News) — Two more important Medicare changes are coming in 2016: Starting in April, hospitals in 67 metro areas and communities will be responsible for managing the total cost of Medicare-covered hip and knee replacements. The experiment covers a 90-day window from the initial doctor’s visit, through surgery and rehabilitation. At stake for the hospitals are potential financial rewards and penalties. Medicare’s goal is to improve quality while lowering cost. But hospitals worry about financial consequences and advocates for patients say there’s a potential to skimp on care. This new initiative will need watching.
And about HOSPICE: Patients choosing hospice care at the end of their lives have traditionally had to give up most curative treatment because Medicare does not cover that cost (other than palliative care) while in hospice. Under Medicare’s new Care Choices model, patients with a terminal illness will be able to receive hospice services without giving up treatment. A cancer patient could continue to get chemo, for example. Seventy hospices started the experiment on January 1st, and another 70 will join in two years.
A Medicare Nugget, January 30, 2016
(from Stan Cohen for The Bridgton News) — Medicare Part B covers certain diagnostic eye tests, and treatment of conditions of the eye. Although Medicare will not generally pay for routine eye care, it will cover once-a-year glaucoma screenings for those at risk, including individuals with diabetes or a family history of glaucoma.
Generally, people who get periodic eye exams (which are highly recommended for seniors like us) are automatically screened for Glaucoma which is a group of diseases that can cause optic nerve damage, sight impairment, and eventual vision loss. Glaucoma cannot be cured, but symptoms can be lessened or prevented with early detection and treatment. Those with Medicare Advantage plans should check with the plan about coverage for eye exams.
Medicare Volunteer Counselors are available for free, one-on-one consultations. Call SeniorsPlus at 1-800-427-1241 to arrange for an appointment.
A Medicare Nugget, January 14, 2016
(from Stan Cohen for the Bridgton News) — If your doctor wants to change your prescription or prescribe an additional drug, make sure that your Medicare drug plan covers the medicine. Show your doctor a copy of your Part D plan’s drug list (formulary). You should have received a copy of the formulary when you received your plan ID card. If you do not have the plan’s formulary, call the plan (their phone number is on the back of the ID card) and ask them if the newly prescribed drug is covered. Alternatively, your physician can go “on-line” to the plan’s web site to find out.
If your doctor wants to prescribe a drug for you that is not covered by your Part D plan, you can request a “coverage determination”. You, your doctor, or your appointed representative can call your plan or write them a letter to request that they cover the prescription you need. If the plan denies your request you can appeal. The best place to get help with your appeal is Maine Legal Services for the Elderly. They have a special hot line for this very purpose [1-877-774-7772] and can provide your doctor with the necessary information. Once your plan has received your request, it has 72 hours to notify you of its decision. Take note: Medicare beneficiaries often win their Part D appeals.
Medicare counselors are available for free, one-on-one consultations. Call SeniorsPlus at 207-795-4010 to schedule your appointment.