Archive for Original Medicare

Ann Cooke | 05/17/2013
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Not Signing Up for Medicare Part B? You May be Headed for a Penalty

parking_fine

Even though I said we’d be talking about Part D this week, I just wanted to add a bit more on Part B and the potential penalty for not signing up when eligible.

What is the Part B late enrollment penalty? If you don’t sign up for Part B when you’re first eligible, (see the prior post for information on enrollment) you may have to pay a late enrollment penalty that may increase your premium by as much as 10% for each 12-month period that you could have had Part B, but didn’t. Unlike the penalty for Part A, there is no end to the Medicare Part B late enrollment penalty. You will carry this penalty for as long as you have Medicare Part B.

You may be able to delay enrollment in Medicare Part B without being subject to a late enrollment penalty if you have group health coverage through you or your spouse’s employer or union. You may then qualify for a Special Enrollment Period for Medicare Part B and avoid a late penalty.

It’s important to note that if you are covered by a COBRA or a retiree health plan, this is not considered to be coverage based on employment.  As a result, you will not qualify for a Special Enrollment Period and you must sign up for Medicare when you are eligible to avoid paying a higher premium.

For more information on the late enrollment penalty, review the 2013 Medicare & You booklet that can be found on the Medicare.gov website:  http://www.medicare.gov/Publications/Pubs/pdf/10050.pdf

 

If you have questions choosing a Medicare plan that offers the coverage you need, contact us at MedicareSolutions at 1-800-328-7305 where a licensed sales agent will immediately assist you.

Category: Medicare Tips, Original Medicare | Tags: , , ,
Ann Cooke | 05/10/2013
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Understanding Medicare – Part B


Part B – If you have qualified for Part A, then you’re qualified to receive Part B. In fact, if you’re getting Social Security, you’ll be automatically enrolled when you turn 65, or if under age 65, have certain disabilities. You can opt out. If you’re not getting Social Security, and want Part B, you must apply. You can enroll in Part B a few different ways; call Social Security, visit the Social Security website, or apply in person at your local office.

Premium Payments

The monthly premium for Part B is based on your income.  This monthly fee can be deducted from your Social Security check.

There is also a yearly deductible.  For 2013, it stands at $140 per month. Once you’ve paid this deductible out-of-pocket, your benefits will kick in and Medicare will pay 80% of the cost of most Part B services.

Part B is medical insurance for issues that don’t require hospitalization, including preventive care.  You’ll want Part B for coverage that extends to:

  • Doctor visits
  • Outpatient treatment
  • Preventive care services (screenings & checkups)
  • Home health services
  • Durable medical equipment (including diabetes supplies)
  • Ambulance services
  • Mental health services

If you have questions choosing a Medicare plan that offers the coverage you need, contact us at MedicareSolutions at 1-800-328-7305 where a licensed sales agent will immediately assist you.

Next Installment – Part D

Category: Compare Medicare Plans, Medicare Tips, Original Medicare | Tags: , , ,
Ann Cooke | 05/06/2013
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Understanding Medicare – One Plan at a Time

Understanding the Medicare process and enrolling in the plans that are right for you can be a daunting task. In this series of posts we’ll be taking a close look at each of the Medicare plans with the hope of providing the information to make this necessary step of life a bit easier.

Medicare – Part A - Hospital Insurance 

Parts A, B, and D of Medicare all serve a different purpose. Part A provides hospital insurance.  Almost everyone over the age of 65 is eligible to receive it, but some may have to pay for it.

Eligibility/Enrollment

If you qualify for Social Security benefits, you receive Medicare Part A coverage at no cost. If you never paid Medicare tax while working, you are not eligible to receive Part A free of charge but, you still may qualify to purchase coverage.

You are eligible for free coverage and will be automatically enrolled if:

  • You are 65 years old and are receiving Social Security or Railroad Retirement Board  (RBB) benefits
  • You are under 65 and have been receiving Social Security Disability benefits for 24 months(24 month waiting period is waived for sufferers of Lou Gehrig’s Disease (ALS))
  • You have End-Stage Renal Disease (ESRD) and meet certain requirements

In order to be eligible to purchase Part A, you must fall into one of these categories:

  • U.S. Citizen or Permanent Resident and at least 65 years old
  • Younger than 65 years old and your Part A coverage ended because of employment

To sign up to purchase Part A, you should contact the Social Security Administration office three months prior to your 65th birthday and tell them you’d like to enroll. You can also sign-up online at www.socialsecurity.gov/retirement. After enrolling, you will receive your Medicare Card and your coverage will begin the first day of the month that you turn 65. You can sign up during the seven month period that starts three months before your birthday and ends four months after. For information on the cost of purchasing Part A, visit – http://www.medicare.gov/your-medicare-costs/part-a-costs/part-a-costs.html

What does it Cover?

As the name implies, Part A – Hospital Insurance covers expenses incurred from hospital visits. Coverage includes:

  • Inpatient hospital care
  • Skilled nursing facility care
  • Home health care
  • Hospice care
  • Inpatient care in a Religious Nonmedical Health Care Institution

If you have questions choosing a Medicare plan that offers the coverage you need, contact us at MedicareSolutions at 1-800-328-7305 where a licensed sales agent will immediately assist you.

Category: Medicare News, Medicare Tips, Original Medicare | Tags: , , ,
admin | 07/17/2012
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Are You Ready For Annual Enrollment?

The Annual Enrollment Period is quickly approaching. This is the period of time where you can make changes to you Medicare coverage. Between October 15th and December 7th every year, you may join, drop, or switch Medicare Prescription Drug and Medicare Advantage plans. You may also choose to revert back to original Medicare Part A and B and leave third party coverage altogether. The changes you make will be effective for the following year, so it is very important that you make sure that you are satisfied with any changes you plan to make. Weighing your option in Medicare is difficult, especially when you are altering an existing Medicare plan. We at Medicare Solutions have put together a short list of questions to help you evaluate your current plan. That way you can make any necessary changes with confidence.

  • Are your monthly medications the same or have others been added that could possibly put you in the ‘donut hole’ sooner than expected?
  • Are you seeing the doctors you need or want to see? Are you visiting the doctor more frequently?
  • Are your copays manageable based on your habits or are they putting you over budget? Are the remaining copays after your Medicare discount still too high for your budget?
  • Are you seeing doctors that are within your network? If you are seeking treatment outside your network, how much extra is it costing you?
  • Does your plan charge a monthly premium? (In addition to your Part B premium)
  • Do you find yourself with a new diagnosis that requires extra benefits that were not included in your original policy choice?
  • Are you utilizing vision, hearing, dental and/or wellness health programs that may or may not be embedded in your policy?

If you are realizing that you aren’t satisfied with your current plan, don’t worry. You have plenty of time to explore different options and make any necessary changes. If you are not satisfied with your current Medicare Advantage plan, Prescription Drug plan, or even Original Medicare plan, then you may choose to do one of the following during the Medicare Open Enrollment Period.

  • Change from Original Medicare to a Medicare Advantage Plan.
  • Change from a Medicare Advantage Plan back to Original Medicare.
  • Switch from one Medicare Advantage Plan to another Medicare Advantage Plan.
  • Switch from a Medicare Advantage Plan that doesn’t offer drug coverage to a Medicare Advantage Plan that offers drug coverage.
  • Switch from a Medicare Advantage Plan that offers drug coverage to a Medicare Advantage Plan that doesn’t offer drug coverage.
  • Join a Medicare Prescription Drug Plan.
  • Switch from one Medicare Prescription Drug Plan to another Medicare Prescription Drug Plan.
  • Drop your Medicare prescription drug coverage completely.

Are you satisfied with your Medicare plan? Are you having second thoughts about your current coverage? Let us know in the comments section!

 

Category: Compare Medicare Plans, Medicare Advantage, Medicare News, Medicare Tips, Original Medicare, Prescription Drug Coverage | Tags: , , , ,
admin | 06/14/2012
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Your Medicare Plan’s Half Birthday

Medicare Plan Half BirthdayIf you opted to change your Medicare Advantage or Prescription Drug Plan during Open Enrollment last year, then you’ve had your new policy for over half a year. At this point, you most likely have a good sense of how the plan is performing for you and your needs. It is a very good idea to take this opportunity to evaluate your plan and decide whether or not you need to make use of the Open Enrollment Period this year. To make things a little easier, we have included a short list of questions to help you figure out if it’s time to explore new Medicare options.

  • Are your monthly medications the same or have others been added that could possibly put you in the ‘donut hole’ sooner than expected?
  • Are you seeing the doctors you need or want to see? Are you visiting the doctor more frequently?
  • Are your copays manageable based on your habits or are they putting you over budget? Are the remaining copays after your Medicare discount still too high for your budget?
  • Are you seeing doctors that are within your network? If you are seeking treatment outside your network, how much extra is it costing you?
  • Does your plan charge a monthly premium? (In addition to your Part B premium)
  • Do you find yourself with a new diagnosis that requires extra benefits that were not included in your original policy choice?
  • Are you utilizing vision, hearing, dental and/or wellness health programs that may or may not be embedded in your policy?

If the answers to these questions have you feeling that your plan isn’t meeting your current needs, it may be time to start thinking about a new one. The Medicare Open Enrollment Period runs from October 15th to December 7th. This may sound far off at this point in the year, but it is important to be prepared so you can make the right choice. If you are not satisfied with your current Medicare Advantage plan, Prescription Drug plan, or even Original Medicare plan, then you may choose to do one of the following during the Medicare Open Enrollment Period.

  • Change from Original Medicare to a Medicare Advantage Plan.
  • Change from a Medicare Advantage Plan back to Original Medicare.
  • Switch from one Medicare Advantage Plan to another Medicare Advantage Plan.
  • Switch from a Medicare Advantage Plan that doesn’t offer drug coverage to a Medicare Advantage Plan that offers drug coverage.
  • Switch from a Medicare Advantage Plan that offers drug coverage to a Medicare Advantage Plan that doesn’t offer drug coverage.
  • Join a Medicare Prescription Drug Plan.
  • Switch from one Medicare Prescription Drug Plan to another Medicare Prescription Drug Plan.
  • Drop your Medicare prescription drug coverage completely.

With so many options, it is easy to get confused. Changing your Medicare coverage is a big decision, and if you end up switching to a plan that is not what you hoped for, you’ll be stuck with it for the entire year. It is never a bad idea to ask for help in order to make the best decision. Medicare Solutions has licensed Medicare experts who can put difficult information into simple terms. And the best part is their expertise and advice is free of charge. Don’t hesitate to call 1-877-614-2333 today to speak with our Medicare experts to get the information you need to be ready for Open Enrollment.

Category: Medicare Advantage, Medicare Tips, Original Medicare, Prescription Drug Coverage | Tags: , , , , , ,
admin | 05/30/2012
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Shingles Vaccine, Medicare, and You

Shingles Vaccine

You may have noticed pharmacies advertising that the shingles vaccine is in stock and available. The CDC’s list of recommended immunizations is constantly evolving and the most recent addition is the shingles vaccine for all adults age 60 and over. This has many seniors wondering if they should receive the shot and if Medicare covers the cost.

Should you get the shingles vaccine?

Over 95% of the people in the United States are infected by the Varicella zoster virus at some point in their lifetime. The virus causes the common childhood disease of chickenpox and then lies dormant within the nerve cells. In approximately one third of the population the virus will re-activate later in life as shingles: a contagious, nasty, blistering rash that can cause severe, debilitating pain that may last for weeks, months or even years (called post herpetic neuralgia). It can also attack the eyes and permanently damage vision (though this is less common).

These numbers equate to over 1 million people being affected by this virus. So it’s no surprise that the CDC recommends a single dose of the zoster vaccine Zostavax for men and women 60 years of age and older, even if they have had a prior episode of shingles.

Recently, a study published online in the Journal of Internal Medicine has shown the vaccine to be safe, and well tolerated in a controlled study of 193,000 adults age 50 and over. Studies have also shown the vaccine to be effective; with results similar to those found in clinical trials in 2006 it was first approved. The vaccine reduced the risk of developing shingles by more than half, and minimized the effects of the disease in those that developed it.

The over 60 crowd is often the higher risk group for contracting disease due to declining immunity, co-existing health issues, multiple diagnoses, or even increased stress factors. The CDC recommends the immunizations, but you should consult your doctor to determine if the vaccine is right for you.

How much does it cost and will Medicare pay for it?

Currently, the only vaccines covered under Medicare Part B are: Flu, H1N1, Pneumococcal, and Hepatitis B. So if you have strictly traditional Medicare the answer is no.

Technically, Part D plans will cover the vaccine and administration, but it may require some advance planning and organization on behalf of the beneficiary to ensure the claim gets paid.

In fact, Medicare.gov states:

“Except for vaccines covered under part B, Medicare drug plans must cover all commercially available vaccines (like the shingles vaccine) when medically necessary to prevent illness. Contact the plan for its current formulary.”

According to Merck, the manufacturer of Zostavax:

“Medicare Part D = Prescription Drug Benefit 90% of Medicare Part D insured individuals are in plans that have ZOSTAVAX on formulary. The availability and amount of reimbursement will depend on a patient’s insurance benefit design, including applicable co-pays, coinsurance, deductibles and/or limits.”

The vaccine is usually around $200, so the time and homework required to ensure re-imbursement is worth the investment.

Check specifically with your Part D plan carrier as a first step. Some plans may require prior authorization, which means your doctor must first get approval before you can receive it. Your doctor may need to state that the drug is ‘medically necessary’ because he feels you are at high risk for contracting the disease for any reason. Some plans and/or some states may also authorize your pharmacist to administer the vaccine in the pharmacy and can bill insurance plans directly if they are in-network.

To date, the shingles vaccine has been underutilized. Past stocking issues by pharmacies and physician’s offices, cost, and challenges with ease of reimbursement under Medicare part D plans are all to blame. Medical spending to treat shingles or its complications totaled $566 million in 2005 or an average of $525 per patient. When these expenses are projected on the sheer number of people who are subject to developing the disease, it seems the recommendation to receive this vaccine is a prudent one.

As more patients request and file claims for vaccine re-imbursement, hopefully the process will become more routine to claim handlers and the confusion or misinformation regarding whether or not the vaccine is paid for and how, will diminish over time.

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Understanding Medicare plans and their coverage can be confusing. If you need to discuss any questions or concerns you may have regarding your current Medicare insurance needs, the knowledgeable, licensed staffs at Medicare Solutions is available to assist you. Call us at 1-877-614-2333

Category: Original Medicare, Prescription Drug Coverage, Senior Healthy Living | Tags: , , , , , ,
admin | 05/24/2012
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Seniors Parade to Preventative Care

preventative care

While many may be marching off to a local Memorial Day parade, a record number of seniors are jumping on the preventative care band wagon.  CMS announced today that 12.1 million Medicare beneficiaries used free preventative care in the first quarter of 2012.

Over 26 million people in traditional Medicare received free preventative services in all of 2011, so today’s announcement reveals seniors are on track to surpass even last year’s numbers.  Prior to 2011, beneficiaries were subject to co-pays and deductibles for many of these services including things like cancer screening and smoking cessation counseling.  Cost is now less of an obstacle for seniors who are interested in finding and treating illness early.

One of the mandates of the ACA (Affordable Care Act) was to eliminate many cost sharing barriers for beneficiaries to obtaining preventative care.  As a result, a new expanded list of screenings and services designed to help identify and detect early disease, was made available to Medicare recipients cost free.

CMS announced that, from January through April of this year, 12.1 million Medicare beneficiaries have already received at least one of these preventative services – including over 856,000 who have taken advantage of the Annual Wellness Visit that is now provided at no cost.

Do you know what screenings are offered? Learn more about Medicare Preventative Services and Procedures.

Have you received any preventative services in 2012? Share with us.

Category: Original Medicare, Senior Healthy Living | Tags: , , , , , , , , ,
ElizabethGHoward | 12/30/2010
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Medicare 2011: Wellness Visits at No Charge

Starting on January 1, 2011, Medicare patients can plan to see a primary care physician every year for a physical, with no concern about payment.

If you are new to Medicare, you will be covered with a one-time “Welcome of Medicare” exam.

After you’ve had Part B for 12 months, you can schedule a yearly “Wellness” visit to develop or update a prevention plan just for you. You’ll pay nothing for this exam if the doctor accepts assignment. This exam is covered once every 12 months.

According to Joe Baker, president of the Medicare Rights Center, as a result of health reform, people with Medicare will no longer have to pay coinsurance, copays, or deductibles for preventive services that are given a grade A or B by the United States Preventive Services Task Force. 

At your annual visit, Baker says, you can expect the doctor to take your family history, collect information about your current health condition, the drugs you are current taking, check blood pressure, and screen you for “conditions related to cognitive impairments.”

The changes made in Medicare continue to show a shift in focus to prevention and wellness. Other services which are covered include other preventative services such as:

  • Diabetes screening
  • Diabetes services and supplies
  • Testing for heart disease
  • Mammogram screening
  • Pap smears and pelvic exams
  • Colon cancer screening
  • Prostate cancer screening
  • Flu shots
  • Hepatitis B vaccine
  • Medical nutritional therapy

 

For a complete list of Medicare preventative services (and a printable checklist), click here.

Category: Original Medicare, Senior Healthy Living | Tags: , , , , , , , , ,
Sophie Callahan | 07/17/2009
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Proposal Suggests Formation of A New Agency To Set Medicare Pay Rates

The White House has recently been circulating draft legislation that would create an executive agency for the purpose of overseeing Medicare reimbursement rates and policy changes. Under the proposal, there would be a paid five-member Independent Medicare Advisory Council whose members would serve five-year terms. They would be nominated by the president and subject to approval by the Senate. In all likelihood, the members of the council would be doctors, or other people who are highly skilled in health policy.

The members of the council would be given the authority to make broad recommendations about Medicare, but they would focus on setting appropriate payment rates for Medicare Part A and Part B. The council would give two annual recommendation reports: the one due by October 1st of each year would deal with Medicare Part A and the one due by December 31st of each year would address Part B. These recommendations would be sent to the White House for the president’s approval before being brought before Congress. This legislation, if enacted will go into effect after Obama’s first term as president on September 15, 2014.

Other proposals are also being given consideration with respect to Medicare. In particular, the Obama administration wants to give the Medicare Payment Advisory Commission (MedPAC) the authority to determine cuts and makes other changes to Medicare.

Category: Medicare News, Original Medicare | Tags: , , ,
Annie Finneran | 07/13/2009
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Madoff Victims May Be Able to Get Part B Premiums Reduced

Part B premiums are determined by the previous year’s tax returns. For most people, the income from the previous year isn’t always accurate. Many events can occur in one year including marriage, divorce, death, loss of job or any other life changing event. Social Security may lower your Part B premium if any of the above events occur. By providing evidence of a death, marriage, or divorce certificate, or a letter from an employer, Social Security will lower your Part B premium according to your current income.

Many people were victims of Bernard Madoff’s fraud and have lost a considerable amount of income due to this scheme. Originally, Madoff victims were not included in the above categories of life changing events. As of June 9, Social Security determined that “if someone had a reduction of income as the result of criminal theft or an investment scam, they can qualify as having a life-changing event.” Just like the above instances, you need to provide documentation to Social Security. Documentation would include an account statement from Madoff’s firm or a court document stating you as an alleged victim.

If you are an alleged victim or have had a life changing event recently, visit http://ssa.gov/online/ssa-44.pdf to fill out a form to request a reduction in your Medicare Part B premium.

For the full article, go to http://online.wsj.com/article/SB124546138795033219.html

Category: Medicare News, Original Medicare | Tags: , , , ,
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