Some Medicare beneficiaries, those that are fairly new to the program, are not aware that if they do not agree with a payment decision or coverage decision made by a Medicare health plan or by Medicare, that they might file an appeal.
There are five levels involved in the appeals process and a beneficiary can proceed up a level if the appeal is denied at a lower level. In order to prepare for an appeal, make sure to gather any and all information from your physician or healthcare practitioner.
If you need a quick decision because your health is in jeopardy, you may request a quicker decision. If your doctor or your Medicare plan agrees, a decision must be delivered within 72 hours.
Always be aware of what Medicare covers and does not cover and what options are available to you if you disagree with decisions made that may affect your health.
Many Medicare beneficiaries do not realize that once they sign up for Medicare they are eligible to get a number of free preventive services. Additionally, for new beneficiaries, Medicare Part B offers a â€śWelcome to Medicareâ€ť preventive visit during the first 12 months of enrollment. During this visit, your doctor will review your medical history and provide you with information regarding any services you may need. Beneficiaries who have had Medicare Part B coverage for over 12 months qualify for an annual wellness visit to update or get a personal health care plan from your doctor.
Medicare also provides its beneficiaries with other free preventive services. Some of these services are listed below:
A cardio-vascular screening every five years
Annual flu shots
Annual screenings for prostate cancer
Annual screenings for cervical cancer
Annual screenings for colorectal cancer
When you sign up for Medicare, take the time to find out what it offers. Preventive services are important for all beneficiaries to take advantage of as theses benefits lead healthier lives. Always read your health care insurance policies and if you have questions, speak to a health care insurance expert agent.
While Medicare costs seem to always be increasing, the good news is that the coverage gap, part of Part D, is going down.
The coverage gap, also known as the â€śdoughnut holeâ€ť is a temporary limit on what Part D, the drug plan, will cover for prescription drugs. In other words, the doughnut hole is defined as the period where you pay for your drugs out of pocket.
Not everyone will enter the doughnut hole. The doughnut hole begins only after you and your plan have spent a certain amount on covered drugs. In 2017, that doughnut hole or gap starts when total drug costs reach $3,700. If a beneficiary is in that hole, they get a 60 percent discount on brand-name drugs and a 49 percent federal government subsidy for generic medications.
In addition, there also is catastrophic coverage where the government starts picking up most drug costs when out-of-pocket expenses for a patient are over $4,950.
It is always a good idea to check into your health insurance options periodically. It is important for you to understand your coverage and how it changes.
There are a number of opportunities to enroll in Medicare. Being aware of all the possible enrollment periods can help you avoid penalties.
There are multiple enrollment windows in addition to the initial seven-month initial enrollment period. If you missed signing up for Part B during the initial enrollment window, you are not working or are not covered by a spouseâ€™s health insurance through work, you may sign on for Part B during the general enrollment period from January 1 to March 31. If you sign up during that period, you coverage begins July 1. However, you will pay a life-penalty of 10 percent for each 12-month period you did not sign up for Part B.
If you are currently working and are covered by an employerâ€™s plan, you may sign up later without penalty during a special eight month enrollment period applicable if you lose employer health care coverage. If this special enrollment period is missed, you need to enroll in the general enrollment phase.
The open enrollment period, from October 15 to December 7 every year, permits you to change Part D plans or Medicare Advantage for the next year. Note that you may now change Medicare Advantage plans outside of the open enrollment period if you choose a plan with a government awarded five-star quality rating.
Ideally, it is best to sign up for Medicare early, but you can certainly wait until your 65 birthday. It is important to remember though that signing up late may incur penalties that increase your monthly payments permanently.
If you already receive Social Security benefits, you are automatically enrolled in Parts A and B. You can opt out of Part B, since is has a monthly cost. However, if you choose to keep it, the premium cost will be deducted from your Social Security benefits.
If you are not on Social Security, you have to sign up for Parts A and B yourself. Starting three months before your 65 birthday, there is a seven-month period referred to as an initial enrollment window that begins. This window closes three months after your birth month. To make certain you get coverage for when you turn 65, you need to sign up in the first three months.
You may be able to delay signing up for Medicare is you are still working and your employer is providing health insurance or if you happen to be on a working spouseâ€™s health insurance plan. If you lose coverage provided by an employer, you must sign up for Medicare within eight months to avoid serious penalties when you enroll.
Selling Medicare Supplement plans is a booming business. Medigap plans were enrolled close to 12.6 million American seniors in 2016, up six percent from 2015.
The sale of Med Supplement plans or Medigap is doing well with not signs of slowing down. In fact, the most recent Healthcare Business Strategy report, authored by Mark Farrah Associatesâ€™ (MFAs), Medicare Supplement plans paid out $21.7 billion in claims in 2016 and earned $27.9 billion in premiums.
The most popular Medigap plan was Plan F, which is considered to be one of the most comprehensive policies available on the market today. According to MFAs figures close to 7 million people enrolled in Plan F representing 55 percent of the market. However, in 2020 Plan F will no longer exist as an option for newly eligible Medicare recipients thanks to the Medicare Access and CHIP Reauthorization Act of 2016 (MACRA). A second Medigap plan that grew in popularity was Plan G, registering a jump of 364,000 members in 2016.
American seniors could always rely on the Medicare program to help them stay healthy, while allowing them to choose plans that suit their lifestyle and budgets. However, the future of Medicare is uncertain. While on the campaign trail, Trump stated that he would not cut Medicare or Social Security. However, the budget director Mick Mulvaney, told a conservative radio host that he is looking for ways to reform Social Security, Medicare and Medicaid, working around President Trumpâ€™s campaign trail promise to leave the programs untouched.
Medicaid may face significant changes and become a block-grant program where each state gets a fixed sum of money from the federal government, which may be a smaller amount than what they receive now. At present, the amount of money a state qualifies for is based on how many people are enrolled in Medicaid.
Currently, according to figures presented to the Senate Budget Committee by Mulvaney, the national debt has risen up to $20 trillion, and without reining in social programs such as Medicare and Social Security the debt will continue to grow. Mulvaney advocates core fundamental changes, such as increasing the retirement age and trimming Medicare benefits for wealthier recipients under the age of 55 to help reduce the burgeoning debt.
Last week, President Trump’s proposed budget landed on Capitol Hill. The plan cuts Medicaid, welfare, food stamps and the social security disability program. Trump’s budget, however, faces opposition from both parties and will likely not become law.
Posted on Friday, June 16th, 2017. Filed under Medicare
Generally it is a good idea to get drug coverage when you are first eligible because if you do not, you may pay a late enrollment penalty. You can only avoid a late fee if you either take advantage of the Extra Help program or have other credible prescription drug coverage from a union or employer.
If you do not know if you are going to be assessed a penalty, Medicare will let you to know what the penalty is and what amount you need to pay for your premium. Typically, the penalty is then paid as long as you have a Medicare drug plan. Therefore, it is important to know the deadline of enrollment and do so on time in order to avoid penalties.
There are two ways for you to obtain prescription drug coverage. One way to do this is through a Medicare Prescription Drug Plan Part D, which adds drug coverage to the original Medicare; some Medicare Private Fee-for-Service plans; Medicare Medical Savings Account plans; or some Medicare Cost plans. The second way to get coverage is through a Medicare Advantage Plan Part C where patients get all of Medicare Part A (hospital), Medicare Part B (medical), and Part D (prescription drugs) in this plan. Those who enroll must have Part A and Part B to be in a Medicare Advantage Plan (MA-PD).
Here are the four ways to join a drug plan:
Note: Joining a Medicare drug plan, may impact your Medicare Advantage Plan (Part C) and you will revert back to Original Medicare if you join a Medicare Prescription Drug plan (Part D) and if your Medicare Advantage Plan included coverage for prescription drugs.
Posted on Friday, April 28th, 2017. Filed under Medicare
It is important to understand that not all patients have an annual deductible, so the observations in this post refer only to those who do pay a deductible. Once that deductible limit has been reached, what usually happens is that the patient then has to pay a co-insurance or co-payment for every prescription. Co-payments are typically a fixed dollar amount. Co-insurance payments have the individual pay a percentage of the total cost of the drug.
Medicare Part D also has what is referred to as catastrophic coverage. If a patientâ€™s annual out-of-pocket reaches $4,950 (2017), only a small co-payment or co-insurance amount is paid for all covered drugs for the balance for the year.
If you qualify as low income Medicare Part D has an Extra Help provision that may help an individual or family reduce drug costs even more. Those who qualify do not pay more than $3.30 per covered generic drugs or $8.25 for a brand name covered drug.
Want to find your level of possible Extra Help? Visit the Medicare website at: https://www.medicare.gov/your-medicare-costs/help-paying-costs/extra-help/level-of-extra-help.html
Posted on Friday, April 21st, 2017. Filed under Medicare
Medicare Part D costs vary greatly from one individual to the next. Expenses, per person, change in response to the drug used, the drugstore filling it out, the type of plan and if the person qualifies for Medicareâ€™s Extra Help program. The Extra Help program helps people with low incomes pay prescription drug program costs like premiums, deductibles and co-insurance fees.
Medicare Part D costs vary because all the Part D plans have their own terms and rules for the policies offered. All plans are required to offer minimum coverage that then can be built on with additional offers. For example, some plans will provide tiered systems where only some brand-name drugs are less expensive.
Nonetheless, there are some common features to be found in all Part D Medicare Plans. For instance, most individuals pay a monthly premium that increases with the personâ€™s salary. All patients do not pay the monthly premium and this is applicable when it comes to deductions. Many Part D Medicare plans charge an annual deductible prior to coverage becoming effective. Deductibles are different for each plan. For 2017, Medicare has stated the maximum deductible is $400.00.
Posted on Friday, April 14th, 2017. Filed under Medicare
Medicare Part D requires clients to buy plans from a private insurance company. That means that each insurer offering Part D has its own list of covered drugs, the plan formulary.
In order for each insurance company to be able to provide information to potential and existing clients, they break the drugs into various tiers with differing costs. Thus, the drugs in the lowest tier generally have a lower co-insurance or co-payment cost and vice versa â€” higher-cost drugs usually have a higher co-insurance or co-payment price. There is an exception to this rule, however, if a doctor wants a patient to take a drug in a higher tier, it is possible for patients to obtain the drugs at an affordable price.
The formulary usually stays the same during the year, but it is possible for a plan to change coverage providing it follows Medicareâ€™s rules and regulations. Patients affected by such a change must have at least 60 daysâ€™ notice before changes go into effect. Additionally, a refill request must be honored, plus the patient is offered a 60-day supply under the previous plan before changing to the new plan.
Interested in finding out what drugs are covered in your area? Check out Medicareâ€™s plan finder tool at: https://www.medicare.gov/find-a-plan/questions/home.aspx
Posted on Friday, April 7th, 2017. Filed under Medicare