Medicare

Keeping Up with Medicare – 2012

Medicare is constantly changing and keeping up with what’s new will help you get the most from Medicare.
There are several changes that have occurred for 2012. Here are some of the highlights:
 Between January 1–February 14, if you’re in a Medicare Advantage Plan, you can leave your plan and switch to Original Medicare. If you switch to Original Medicare during this period, you will have until February 14 to also join a Medicare Prescription Drug Plan to add drug coverage. Your coverage will begin the first day of the month after the plan gets your enrollment form.
 Medicare plans are rated for quality by a 5-star rating with 1 star being the lowest and 5 stars the highest. Between December 8, 2011 and November 30, 2012, if you are enrolled in a Medicare Advantage or Medicare Part D prescription plan you can join or switch to a plan that has a 5-STAR rating IF ONE IS AVAILABLE IN YOUR AREA. This can be done only one time during the year.

o NOTE: if you take this opportunity and enroll in a 5-star Medicare Advantage plan that does not provide prescription benefits you will not be able to enroll in a Part D (prescription) plan and you will not have prescription drug benefits until open enrollment which is from October 15 to December 7 2012. So choose wisely!!

o There are not 5-star plans available in many areas of the country. Check the Plan Finder Tool on the www.Medicare.gov website to see if any are available in your area.

 The Donut Hole (the Part D coverage gap) continues to slowly close , one of the positive benefits from the Affordable Care Act passed in March 2010. In 2012 you will continue to pay only 50% of the cost for brand named drugs and your discount for generic drugs will double to 14%. Both discounts will gradually increase until beneficiaries pay just 25% of their drug costs in 2020.
 Medicare now covers screening and counseling for alcohol misuse, depression, and obesity
I you are confused about Medicare there are experts you can speak to. Look for your state’s Department of Aging, or call a Health Care Advocate!

Where do we go from here? Discharge planning after your senior parent’s ER visit

After all of the tests and waiting and treatments are completed, it is time to decide what the next steps are for your Mom or Dad. Here are some possible scenarios.

Scenario 1: The doctor wants your father to stay in the hospital

Ø The first question is … Why?

If it is for a blood test or x-ray that is needed tomorrow, can it be arranged and completed on an outpatient basis?
If it is because he should not be alone for the first 24 hours, can your dad go home with you or can you stay with him?
Does he live in an assisted living facility where you can arrange some nursing care and monitoring?
Can he be sent home with in-home supports you can arrange, such as private home health aides?

Ø The second question is … Will he be admitted or placed in an observation bed?

Keeping your father in the hospital does not necessarily mean that he is going to be admitted!
If the doctor is planning to place your father in an observation bed that means that:

– MEDICARE WILL NOT PAY FOR ANY OF THE HOSPITAL BILLS INCURRED ONCE THE ER TREATMENT IS COMPLETED, AND

– IF YOUR FATHER HAS TO BE TRANSFERRED TO A SKILLED NURSING FACILITY FROM THE HOSPITAL FOR REHABILITATION WITHOUT BEING ADMITTED, MEDICARE WILL NOT PAY FOR ANY OF THE BILLS FROM THE REHAB FACILITY.

If the doctor is planning to admit your father to the hospital, that means that Medicare will most likely pay for his hospital bills, as long as it is a medically necessary admission.

Scenario 2: The doctor wants to discharge your mother

Ø Where will your mother go?

If she lives alone in an apartment or house

– Does she need someone to be with her for a day, a week, or longer?

– Does she have stairs to get to her bedroom or bathroom that are now an obstacle?

If she lives in an assisted living facility, do you need to contact them for added services and supports to be in place before she returns home?

– Can they have these supports available to her immediately upon her return, or does it take some time for them to arrange theses?

Before your parent leaves the ER

Regardless of where your parent will be going, there are several issues you need to discuss with the doctor before your parent leaves the ER.

Need assistance? Wondering what the right thing to do is? Give us a call!

In good health,

The Health Champion Team

Medicare Open Enrollment is NOW- What Should You Do?

Medicare Open Enrollment is earlier this year—October 15 to December 7, 2011.

To save you money and angst, you need to reevaluate your Medicare coverage every year at Open Enrollment!
So let’s get started.
Quick Medicare Primer:

Original Medicare has 2 parts
Part A covers in-patient (hospital) costs-is free for anyone who worked for 10 years and contributed to Medicare through payroll deductions

Part B covers out-patient (doctor visits) costs-has a monthly premium that is deducted from your Social Security check

BUT KEEP IN MIND THAT MEDICARE DOES NOT PAY FOR EVERYTHING YOUR DOCTOR ORDERS AND MEDICARE DOES NOT COVER THE COMPLETE COST OF MEDICAL CARE

You can have just Original Medicare but you are then responsible for all of the medical bills that Medicare does not cover and you will have to pay full price for all of your prescription medicine … OR you can choose additional insurance coverage to help pay for these additional bills.

There are several choices to help cover some of the costs that Medicare does not pay and to lower the cost of your prescription drugs. To take advantage of any of these choices you must have both Medicare Parts A and B.

So here comes the confusing part!

Private insurance companies offer health insurance policies that pay for many of the charges Medicare does not pay for. These are called Medicare Supplement or Medigap Plans. There are 11 different types of plans to choose from. They vary in price and what they pay for.

In general, these are best if you several medical problems, or if you travel, or if you live in more than 1 area of the U.S. during the year, if you want to be able to choose your doctors or treatment facilities without dealing with a restrictive network.

Advantages of choosing one of these plans:

• You can go to any doctor who treats Medicare patients
• You do not have to have a referral to see a specialist
• You will not have to pay a copay when you see a doctor
• You can travel within the U.S. or live in more than one area of the U.S. and get medical care covered by your insurance

Disadvantages of choosing one of these plans:

• Medigap plans do not provide prescription drug coverage, so you must also purchase a Medicare Part D (Medicare Prescription Drug) Plan
• A Medigap plan plus a Medicare Part D plan can be more expensive than purchasing a Medicare Advantage (Medicare Part C) plan—see below

The alternative to adding a Medigap Plan plus a Medicare Prescription Drug Plan (Medicare Part D) to Original Medicare is to choose what is called a Medicare Advantage (Medicare Part C) Plan. These plans are also offered by private insurance companies and the number of plans available to you depends upon what state you live in.

Advantages of these plans
• They are often less expensive than adding Medigap plus a Medicare Prescription Plan (Medicare Part D) to Original Medicare
• These plans are all inclusive-they provide both medical and prescription drug coverage
• They must offer the same level of coverage as Original Medicare, and often have additional coverage—such as limited dental, eye care, and other services—available for an additional monthly cost or no additional cost

Disadvantages of these plans

• They are usually (but not always) HMO plans which means you can only to be treated by doctors in their network for the plan to pay for your medical care
• You will have to pay a copay every time you see a doctor or get a covered service
• If you need medical care outside of the area where you live, these plans only will pay for emergency treatment-you cannot see doctors out of your area

So now it is Open Enrollment:

So what does that mean?

Every year during Open Enrollment anyone who has Medicare—regardless of what type of a plan—should review plan(s) you had this year, look at the plans that are offered for the next year and choose to change your Medicare choices or stay with what you have.

During this time you can:

• Change from Original Medicare to an Advantage plan
• Change from an Advantage plan to Original Medicare
• Switch from one Medicare Advantage plan to a different Medicare Advantage plan
• Switch from a Medicare Advantage plan that offers prescription drug coverage to a Medicare Advantage plan that does not offer prescription drug coverage
• Join a Medicare Prescription Drug Plan (Medicare Part D)
• Drop you Medicare Prescription Drug Plan completely

Why is it important to reevaluate your Medicare coverage every year?

Very simply, things change!!

If any of the following have changed since last year at this time, you need to reevaluate your medical and drug coverage. If you don’t, you may be stuck with a plan that is more expensive or does not cover medical expenses you will need next year.

• Have the medicines you were taking changed?
• Do you have new doctors?
• Do you have a new diagnosis?
• Are you planning any surgeries next year?
• Are you planning to travel or live someplace else during part of the year
• Have you moved?
• Are the doctors you want to see no longer on your plan?
• Are you unhappy with the medical and/or prescription plans you had this year?

So how do you figure out which medical and prescription drug plans are available for next year and which is the best one for you?

You can go to www.medicare.gov and use their site to evaluate next year’s plans
You can contact your state Department of Social Services to see if they have a State Unit on Aging
You can look online for a non-profit group in your area that helps people with Medicare questions
You can ask a friend or relative to help you
You can hire a Private Health Care Advocate to evaluate your current medical and drug status and match you with the best plan(s) for you for next year

However you do it …DO IT

Medicare Open Enrollment

Medicare Open Enrollment – Tis the Season

When the end of summer and the fall season beginning, it signals for those of us in health care that the season of open enrollment will be upon us. Open Enrollment is the time when employers give employees the opportunity to review their insurance benefits, and make decide to renew or make changes.

If you are a Medicare beneficiary the government gives you the opportunity to review your coverage options as well. This year the open enrollment begins earlier than prior years and ends earlier as well. The open enrollment period begins October 15 and ends December 7^th. Enrollees in “original” Medicare can move into a Medicare Advantage Plan during this time. Medicare Advantage enrollees can move into “original” Medicare.

Don’t miss this opportunity to review you current coverage and evaluate whether or not a different Medicare option is a better choice for you in 2012. According to a recent survey done by National Council on Aging and United Healthcare, 46% of seniors have never shopped around for the best Medicare coverage. Medicare should have the 2012 options and pricing available on their website on October 1. Medicare Part D (prescription drug plan) options can also be changed at this time.

While a plethora of choices can be paralyzing for some, here are a few areas to review before looking at your options:

Ø Have you have any new medical issues identified in 2011?

Ø Are these issues likely to continue in 2012?

Ø Have your medications changed in any way? This includes changes to frequency and dosage?

Ø Do you have new medical specialists on your care team? If so, do they participate in Medicare? Do they participate in any local Medicare Advantage plans?

Ø Are you pleased with your current coverage?

Ø Have you moved or plan to move in 2012.

Taking the time to do your homework – understand your own needs, your budget and what your options may save you considerable dollars in 2012.

Confused? Overwhelmed by your choices? Get help! Each state has a organization armed with trained Medicare. Contact the local Area Agency on Aging office . Or, you can call Health Champion, we are in your corner!

Medicare – Enrollment

“Now What” Series

At Health Champion, we hear the phrase “Now What?” from our clients so often, we have decided to create a series of “Now What” blogs.

We hope that these posts will provide you the insight and advice you need to become a successful health care consumer.

Our first “Now What” blog pertains to the following scenario:

You are turning 65, still working and plan on continuing to work. Now what should you do about Medicare, if anything?

If you have health benefits from your employer and you are continuing to work, you should sign up for Medicare Part A. You should also speak to your human resources department to determine whether or not to sign up for Medicare Part B. If you decide to enroll in Medicare Part B, then the question is, which of your insurances is the primary payer of your health care? In general, the size of the employer group determines who is primary payer for “the working aged”. (Could we please replace that phrase with something like “HIP Older Person?). Ask your human resources department who your primary payer is.

If you have worked 40 or more quarters you are eligible for Medicare Part A when you turn 65. Medicare Part A covers inpatient hospitalizations, skilled nursing, home health and hospice care and some selected outpatient services. If you have worked the 40 or more quarters there is no cost for Medicare Part A. Most individuals who are receiving Social Security will be automatically be enrolled in Medicare Part A – on the first day of the month you turn 65. If you are not receiving Social Security at age 65, you are still eligible for Medicare, but you will have to enroll yourself by contacting Social Security.

Medicare Part B, which covers physician costs among other types of services, is an option that you must elect. You should enroll in Part B 3 months before the month you turn 65, but can also enroll the month you turn 65 and 3 months after your 65 birthday. You do that by contacting your local Social Security office or on the Social Security website.

If you chose to continue to work past your 65^th birthday, and you are receiving employer sponsored health insurance, you can defer your enrollment into both Parts A and Part B. When your employer coverage ends, you can elect Part A and enroll in Part B. This is called a “special enrollment period.” The 8-month “special enrollment period” begins the month after the employment ends or the group health plan coverage ends, whichever happens first.

A word of caution, if you fail to take advantage of the special enrollment period, you risk paying a penalty later. www.medicare.gov is good resource for general overview of enrollment periods.

For more information go to:

Medicare: www.medicare.gov

Social Security Administration: 1-800-772-1213 or www.ssa.gov.

Your friend at Health Champion,

Ida

Who’s On First?

Following up on our blog from a few weeks ago — having “double the benefits” with two working spouses and two health plans — we’re adding Medicare to the mix.

Sample Scenario —

Husband: takes retirement, is 65 or older (and/or is disabled), and has Medicare as his primary health insurance coverage.

Wife: continues working, has employer based health care benefits for her and her husband.

He goes to the doctor and assumes Medicare will cover the visit and any treatments or tests. But it ain’t necessarily so! And that’s why he MUST let his health-care providers know about his wife’s employer-based plan.

In a nutshell . . .

As a non-active employee (an individual who is retired, on COBRA or Long Term Disability), the husband would typically be covered by Medicare as his primary insurance. However, as a dependent on his wife’s insurance, the size of her employer’s group will determine primacy: if there are fewer than 20 employees, Medicare pays first; more than 20, her health insurance pays first and Medicare pays second.

The rules for coordination can be complex. Keep your health plan administrators informed of changes or other coverage. Make sure your doctors know about the dual coverage and present both cards at the time of your visit.

Questions? That’s our specialty — finding answers, determining solutions. So, call if you need us. You can also contact the Medicare Coordination of Benefits Contractor at 1-800-999-1118.

Meanwhile, just remember, the answer to Who’s on First? can be a tricky one!

Medicare to the Rescue

Quick Test:

Are you — or someone you’re caring for — on Medicare and suffering from a variety of chronic health conditions?
Do you worry about taking all those meds: are they more than you need; are they even necessary?
Are you concerned about side effects or drug interactions?

If you’ve answered “yes” to any of the above questions, it’s time for answers. And you won’t have to search high and low to find them. Help is available through a federal program called Medical Therapy Management (MTM), offered by your Medicare Part D or Advantage prescription plan.

With MTM, a clinical pharmacist will:

evaluate your conditions and medications to ensure safe, appropriate, and cost-effective use.
contact your doctor(s) about any problems and work to help resolve them.
meet with you several times a year to help you keep track of all of your medicines and conditions and monitor your progress.
be available for questions and problems as they arise.

The best part? If you qualify, this service is free!

Why is this important?

The more medicines you take, the greater the risk for dangerous interactions, adverse side effects and mismanagement (not taking them as directed), leading to serious consequences. In fact, this is a growing public problem across the United States. Experts estimate that 1.5 million preventable adverse events occur each year, resulting in $177 billion in injury and death.

Find out if you qualify.

Contact your Medicare Part D prescription plan or your Medicare Advantage Plan; ask about their MTM services and how to qualify. Also ask for the names of clinical pharmacists in your area. It’s that simple.

Do this for yourself. Be Informed. And stay healthy!

Alexa Ray can find get one, why can’t the average consumer?

We were sorry to hear the news about Billy Joel and Christine Brinkley’s daughter, Alexa Ray, who apparently attempted suicide. We’re deeply saddened for her and her family and wish them healing and support.

Among other things, this tragic incident once again calls attention to the disparity between the “haves and have-nots” when it comes to getting good mental health treatment. Depression and other psychiatric problems cross all age and economic boundaries. But access to appropriate care does not.

No offense to Alexa, but we bet she won’t have any problem getting the help she needs. It’s not so easy for the rest of us. Especially those on Medicare.

Private health plans are required to demonstrate credible provider networks across all medical specialties. They also have to show they have contracts in place and that appointments are available.

Medicare (original), on the other hand, is not held to similar standards. In addition, docs are leaving Medicare due to low reimbursement. The result? Inadequate networks of providers across specialties and across the country. If Medicare was a private health plan, this situation would be blatantly unacceptable.

If you’re on Medicare and having trouble finding a qualified mental health professional, here are some tips. And, if you’re uncomfortable advocating for yourself, enlist the help of someone you trust.

Explain you’re paying out-of-pocket to a provider who doesn’t take Medicare; ask for a block of sessions at a discounted price.

Contact Medicare for a list of participating mental health providers. Call 1-800 Medicare. Verify current participation.

Use these national resources:
National Institute of Mental Health Information Line:
Provides information and literature on mental illness by disorder for professionals and the general public. Call: 1-800-647-2642
National Mental Health Association:
Provides information on specific disorders, referral directory to mental health providers, national directory of local mental health associations, and a Stigma Watch. Call: 1-800-969-NMHA (800-969-6642)
Share your story. Giving voice to the problem is essential for positive change.

Health Champion Blog

"In Your Corner"