Category Archives: Uncategorized

Protect your Medicare Card from Fraud

Medicare card fraud is rampant during open enrollment periods, which is currently running until December 7th. Medicare fraud results in higher health care costs for taxpayers, so it’s important to know how to protect your Medicare card and number. The most imperative thing to keep in mind is that your Medicare card should be guarded with the same security as your credit card. Doctors or hospital settings are the only people who should have those numbers.

Safeguard your card by taking the following steps:

Keep your Medicare number private. If anyone calls asking for your number, don’t give it. This is a common Medicare scam.
Money or gifts for free medical care should be refused. It’s a common ploy by identity thieves who say they need your number to verify certain things.
Keep track of your doctor’s appointments and upcoming tests, and use a calendar to record appropriately. Look for items and services listed on your Medicare statements, along with other details that might be incorrect. If you see a suspicious charge or service and you know the provider, call the office directly to inquire.
Stay alert during the coronavirus pandemic since con artists take advantage of people who are highly distracted or disoriented.

If you suspect Medicare fraud, call 1-800-Medicare or call the Medicare Drug Integrity Contractor at 1-877-7SAFERX. To speak with a professional regarding your Medicare plan, contact Senior Health Medicare today.

Senior Health Medicare is a superior resource for Medicare guidance, information, and ongoing client support. Selecting a Medicare plan is not a frivolous decision. It requires annual revisiting and re-evaluating in order for the client to stay in the most cost-effective coverage. Senior Health Medicare is here to serve as your resource through all the years to come. Contact us today at 888-404-5049 or visit us on the web at www.seniorhealthmedicare.com. Written by the digital marketing staff at Creative Programs & Systems: www.cpsmi.com

Four Things to Ascertain About Your Retiree Insurance Coverage

If you have Medicare and a group health plan (retiree coverage from a former employer), Medicare will generally pay your healthcare bills first, and your group health plan coverage pays second. Below are some questions you can ask yourself to help navigate your retiree insurance coverage versus Medicare coverage.

Following your retirement, will your employer coverage continue? When you have retiree coverage from an employer or union, they generally control it. Employers are not required to provide retiree coverage; they can modify benefits, premiums, or cancel coverage.
Do you know the cost and specific coverage? Employers or unions might offer retiree coverage for you and/or your spouse but under certain limits and restrictions. It might only provide “stop loss” coverage, which begins paying your out-of-pocket costs once they reach a certain amount.
When you are eligible for Medicare, what happens to your retiree coverage? If you were eligible for Medicare but didn’t sign up for it during any period of time, retiree coverage might not pay your medical costs. When you become eligible for Medicare, it is imperative that you enroll in both Part A and Part B to get full benefits from your retiree coverage.
How does your retiree coverage work with Medicare? Obtain a copy of your plan’s benefit booklet and check out the summary plan description. Your employer or union usually provides this. You can also call your employer’s benefits administrator if unable to locate this information in the booklet.

If your former employer goes bankrupt or closes the business, Federal COBRA rules might protect you if any other company within the same corporate organization continues to offer a group health plan to its employees. That specific plan is required to provide you with COBRA continuation coverage. If COBRA continuation coverage is unavailable to you, purchasing a Medigap policy is possible, even if you are no longer in your Medigap open enrollment period.

Your State Health Insurance Assistance Program (SHIP) can advise whether to purchase a Medicare Supplement Insurance (Medigap) policy. Your retiree coverage is probably similar to coverage under Medicare Supplement Insurance (Medigap) since Medicare pays first after you retire. Retiree coverage isn’t the same thing as a Medigap policy, however, they both usually offer benefits that fill in some of Medicare’s gaps in coverage (coinsurance and deductibles.) Sometimes retiree coverage provides extra benefits such as coverage for additional hospitalizations.

For more information regarding Medicare or retiree coverage, contact the experts at Senior Health Medicare today. We strive to provide answers with quality customer service, satisfaction, and care.

Senior Health Medicare is a superior resource for Medicare guidance, information, and ongoing client support. Selecting a Medicare plan is not a decision to take carelessly. It requires annual revisiting and re-evaluating in order for the client to stay in the most cost-effective coverage. Senior Health Medicare is here to serve as your resource through all the years to come. Contact us today at 888-404-5049 or visit us on the web at www.seniorhealthmedicare.com.

Written by the digital marketing staff at Creative Programs & Systems: www.cpsmi.com.

COVID-19 Sparks Regulatory Changes to Medicare

In response to the global COVID-19 pandemic, Congress and the Trump administration implemented a record number of legislative, regulatory, and sub-regulatory changes to the Medicare program. These alterations allow for unprecedented flexibility to healthcare providers, Medicare Advantage Plans, and Part D plans. Some of the changes waived Medicare participation conditions, allowing patients to be treated in alternative care settings. Other changes allow for telemedicine services to be eligible for Medicare reimbursement to physicians and other healthcare providers.

Significant COVID-19 changes that include telecommunication reimbursement include telephone visits, physician supervision services, urban and rural areas, and new sites (including patient homes). Hospitals can now provide alternative services at locations, including other healthcare facilities, expansion sites (hotels or community facilities), and specific services at patients’ homes. Moreover, licensed providers can provisionally offer services outside of their enrollment state.

Both the benefits and unintended consequences of these policy actions should be carefully analyzed by policymakers and stakeholders to provide patients access to healthcare, and so providers can offer high-quality care. As the COVID-19 pandemic continues, stakeholder input and analyses should inform the regular rulemaking process to guarantee any permanent governing adaptations improve the Medicare program. The effects of these policies should be meticulously studied to determine the most efficient way to prepare for future public health emergencies.

Want to know more about the new regulations or need some assistance navigating through Medicare terminology, plans, policies, etc.? Look no further; Senior Health Medicare is here to help you find your path through the Medicare world. Click here to read more information about regulatory changes.

Senior Health Medicare is a superior resource for Medicare guidance, information, and ongoing client support. Selecting a Medicare plan is not a flippant decision. It requires annual revisiting and re-evaluating for the client to stay in the most cost-effective coverage. Senior Health Medicare is here to serve as your resource through all the years to come. Contact us today at 888-404-5049 or visit us on the web at www.seniorhealthmedicare.com.

Written by the digital marketing staff at Creative Programs & Systems: www.cpsmi.com.

Everything Enrollees Should Know About This Year’s Changes in Medicare

Since there are changes in Medicare all the time, it is essential for all beneficiaries to stay informed regardless of how minor the changes from the previous year might be. 2019 has brought in many variations including an early close in the Donut Hole, expansion in Medicare Advantage, and changes in premiums and deductibles. Also, Medicare is eliminating all “Cadillac” Medicare Supplement plans (including F and C) as a way to save money as the baby boomers come into the Medicare system at a rate of 10,000 every day.

High Volume of Enrollees

In 2020 it is expected that the Medicare costs will double due to the amount of retiring baby boomers. At this point, there will be more people on Medicare than paying in. For Medicare to save money in the future, it must make changes in Plans or rule them out for new beneficiaries. Medicare taxes and the Trust Fund continue to cover less since health care costs are rising faster than economic growth.

Plans F and C

2019 marks the last year for Plans F and C. On January 1, 2020; these plans will no longer be available to new enrollees. In 2015 the Medicare Access and CHIP Reauthorization Act (MACRA) was passed to prohibit the sale of Medigap plans that pay for Part B deductibles. If a beneficiary already has Plan C or F you can continue to purchase these plans after the New Year. People that already have these plans are “grandfathered” in, but we have found that when plans close to new enrollees, the likely outcome is rate increases on the premium at a faster volume and rate than open plans.

Part B

In 2018 the standard premium for Medicare Part B was $134 a month and had gone up to $135.50. Some Enrollees will pay less because their premium amount depends on their Social Security Cost of Living Adjustment, which may not cover the increase.

Previously, the highest income bracket for Part B enrollees was $160k and above. This year a new bracket of $500k and above was added with a premium of $460.50 a month.

The deductible has increased from $183 to $185 per year, and once you meet this, then you are responsible for 20% of the Medicare-approved amount for services. This exposure has no cap- if you go in for major surgery, you will pay 20% unless you have a Medicare Supplement or Advantage plan to ease the burden.

Medigap plans that cover the Part B deductible can be sold in 2019 but can no longer be purchased starting 2020. Those who already have these programs can keep Plans C and F, but no new enrollees can buy plans that cover the Part B deductible.

Medicare Advantage

Test drives

Once enrolled in the Medicare Advantage plan, beneficiaries will now be able to try it out for three months, and if they aren’t satisfied, they can switch plans.

Open Enrollment

Starting this year from January 1st to March 31st anyone enrolled in a Medicare Advantage plan can switch plans. New beneficiaries with both Medicare Part A and B plans have a three-month Medicare Advantage Enrollment period.

Broader Span of Coverage

Additional services are available within Medicare Advantage plans including coverage on meal deliveries and transportation services.

The Donut Hole

The Donut Hole is gradually closing due to the Affordable Care Act (ACA). In the past, Medicare beneficiaries experienced higher costs on medications at a certain point in the year due to a gap in coverage. At one point it was 100%. Since the beginning of 2019, the Medicare donut hole only affects generic medications. Beneficiaries will now save money by just paying 37% of those costs while in the donut hole.

Part A

Premiums for people whose work history (or spouses) isn’t 40 quarters are required to pay dividends for Part A coverage (hospitalization costs). Premiums for 30-40 quarters of work history have gone from $232 a month to $240. For less than 30 quarters it was $422 and is now $437. For all enrollees, every benefit period, Part A deductibles increase, though most beneficiaries have coverage that pays for all or part of it.

Every year there are changes in premiums and deductibles, but Medicare is striving to make changes for the better. Some parts that have improved the system include the removal of the therapy cap, an updated handbook, and a broadening of telehealth programs. For any questions about these topics or an expansion on changes in the donut hole, Part B, Part A or Medicare advantage, please leave a comment or give our Medicare Experts a call. We aim to be your educational Medicare resource!

Understanding Part D

Part D may feel difficult to understand, but it is a very important element to grasp an full understanding of. The very first thing to understand is that having a yearly review considering your Part D plan is vital. It is vital because your Part D plan can change on a yearly basis. Your medication, dosage, provider’s location, and cost may change on the since last year.

Medication has tiers ranging from big name brands to generic brands. The cost, and tier requirements may change in which you may benefit or pay extra for the same drugs. When speaking to our experts at Senior Health Medicare, we will not only review your current Part D plan, but we will put together a plan that will give you the same coverage with the best prices. 9 times out of 10 you and your spouse do not share the exact medication, to combat that our experts will create an individual plan for you and your spouse.

Call us now- before October 15^th to get an appointment with our advisers. Enter your medications into our Part D Analysis form on the website. We will do a FREE drug plan comparison and recommend the plan with lowest out of pocket cost based on your medications.

Part D Analysis form: https://seniorhealthmedicare.com/health-ins-form2.php

7 Medicare Tips for New Enrollees

1 Medicare doesn’t have a family plan

Medicare plans are only individual coverage, not family. This means that spouses each need to have their own Medicare coverage. Additionally, no dependents receive coverage. In the event that your spouse is younger than you, when you enroll in Medicare they can seek employer coverage or individual coverage through the marketplace (healthcare.gov — the Affordable Care Act website). Note, that if you and your spouse are entering Medicare around the same time, you may be recommended different plans from different companies if they are a better individual fit for you. Some companies to offer household discounts for enrolling with the same company, but other than that it is unique to the individual.

2 There is no cap on out-of-pocket costs in Original Medicare

Most employer plans have annual limits on your out-of-pocket health expenses. Medicare pays 80% of approved medical expenses, then the beneficiary is responsible for the remaining 20%, without a cap. For example, if you have an $100K surgery, you will have to pay $20K, which is why people buy Medicare Supplement plans or Medigap plans to fill this gap.

3 Make a plan for any pending procedures

If your employer plan offers you better benefits than Medicare or costs less, then you may want to have the elective surgery sooner than later. Or wait until you are enrolled in the Medicare system. Surprisingly, the first year for a Medicare beneficiary usually has the highest number of claims because people wait for elective surgery until they are covered on the system.

4 Observation VS Inpatient

Medicare pays different rates according to status. Even if the patient is admitted in a hospital for one week, if they are under “observation” they are considered as out-patients. Medicare requires a three-day hospital inpatient stay minimum before the covering of cost. When a patient is admitted under “observation” , the time frame is not counted toward the Medicare’s requirement regardless of the length.

5 Research can mean more money in your pockets

In the employer health insurance world, you are stuck with the benefits designed for the group. With Medicare, it should be custom to you and your individual needs. Finding an educational resource to learn more about Medicare and how it works, will only help you make smarter decisions when it comes to health insurance. It can also mean saving money in the process.

6 When you enroll into a Medicare Advantage plan, you are disenrolling from Original Medicare

Medicare Advantage plans were introduced in the early 2000’s as an alternative to Original Medicare parts A and B. The way they are marketed is that they offer the same benefits as Original Medicare, but it’s a little more complex than that. While Original Medicare and Medicare Supplement plans are programs regulated by the government, Medicare Advantage plans are controlled by the insurance companies. It literally takes an act of Congress to change Original Medicare, whereas Medicare Advantage plans are in the company’s hands. You essentially give up your Medicare to work with a network provider. Learn more about the difference between Medicare Advantage and Original Medicare with a Supplement here.

7 You can change your Medicare Supplement coverage whenever you want

You don’t have to wait for AEP to change your Medicare Supplement coverage. You can change your Medigap plan anytime during the year, as long as you can pass medical underwriting. The programs that must wait for changes until AEP are Part D Prescription plans and Medicare Advantage plans.

Leave a comment, let us know which tip is the most useful.

4 Ways to Navigate Medicare

Medicare is not the easiest system to understand let alone to navigate. Here is a few quick facts to make sure you are setting yourself up for major success.

1 If you are currently covered by group employer insurance, you can defer receiving Medicare as long as you want. Once again, this is ONLY if you are covered by employer insurance.

2 Individuals turning 65 years old have six months for the initial enrollment period where underwriting is not a requirement in the process of Medicare. Even though we all love underwriting, this time period allow the process to run even smoother.

3 The initial period is the 3 months prior to your birthday, your actual birthday, and the 3 month post your 65^th birthday. It may seem like a long time now, but those 6 months will pass you if you are not paying attention.

4 If you recently stop receiving employer insurance and over 65 years old, you have a 8 month period after your insurance was discontinued called the Special enrollment period. For example, if your insurance was discontinued in May your special enrollment period will end in December.

Making Medicare Simple and Easy

If you ever wanted a personal assistant, especially with the confusing world of Medicare, My Medicare.gov is an amazing tool! My Medicare.gov is a free, secure, online portal that manages your personalized information regarding Medicare benefits and services. It is very simple to set-up, and can be used to check information about your coverage, enrollment status and Medicare claims.

You can make getting all the necessary information about your coverage, prescription drugs, and health records easy for your doctor and any doctor you may need in the future. You never know when you’ll need to see a doctor while traveling. As you may know, not every doctor has your personal list of medications. This tool allows you to have everything you need at your finger tips.

According to sources at eHealth Medicare, your personal information is protected by the CMS. The CMS is the Centers for Medicare & Medicaid Services, The CMS has many guidelines such as, what type of information is being used, who is collecting the information, and how are they using the information collected. This amazing tool has many other functions for your disposal, so give it try!

Leave a comment, and let us know what would you use My Medicare.gov for?

For more information, click the link below https://www.mymedicare.gov/

6 Things You Should Do Before Medicare AEP Begins Oct. 15

It’s that time of year again, the Annual Election Period (AEP) is upon us. If you’ve been a Medicare recipient prior to this year, then you are all too familiar with the implications of AEP. If this is your first enrollment season, then you’re about to experience what can be a frustrating and stressful time as a Medicare enrollee.

During the Medicare AEP, beneficiaries are able to alter their coverage under specific programs such as Medicare Advantage and Part D Prescription Drug plans. Often times, people make the mistake of thinking this is also the only time to change Medicare supplement plans, however those can be changed anytime throughout the year. The main things to focus on during AEP are switching from or to a Medicare Advantage plan, and entering into or changing your prescription drug plans.

You may be wondering why it is necessary to monitor these plans during the AEP, and the simple answer is that these plans change in coverage and price every year. If you don’t change or do anything to your existing plans, they will likely be much different in price and/or coverage as you enter into the next year. In many cases, the change can be significant. That’s why it’s always worth having your Medicare advisor analyze your existing plans and medications to ensure you’re still in the most cost-effective plan every year during AEP. Don’t wait, you could end up locked into a plan with a much higher premium or with holes in your coverage if you miss the AEP window (October 15^th through December 7^th).

In an effort to curb the stress and confusion that comes from Medicare AEP season, we’ve developed a list of 6 things that you should do to prepare.

Confirm your eligibility. This is pretty obvious, but you must be eligible to enroll in Medicare plans. If you’re unsure of your eligibility, consult this article from the US Department of Health & Human Services website: http://www.hhs.gov/answers/medicare-and-medicaid/who-is-elibible-for-medicare/index.html

Analyze your existing coverage thoroughly. Take some time to consider your past year of coverage. Weigh the pros and cons of the specific plan you’re in, the company/carrier of the plan, the total expenses (including prescription meds) of the year. Consider aspects like how quickly your claims were paid, if your doctor had any trouble with your insurance at any point, and if the out of pocket expenses were worth the healthcare you received.

Make note of any changes in medication or health that could impact your plans. After you’ve done a thorough self-analysis of your past coverage, make sure to note any looming changes that could be upcoming in your health. For example, if your doctor suggested a new medication or treatment that wasn’t previously needed when you set up your original plan. Write this all out and give your coverage an overall satisfaction rating for the year. This will help determine what the next move for you should be, and will make you aware of what you need most out of your healthcare coverage.

Compare prices of plan options for the coming year. There are MANY plans, programs, and carriers to choose from. When it comes time to select your coverage for the upcoming year, it’s essential to decide what type of Medicare beneficiary you are. Are you someone who would prefer to pay a little more on a monthly basis in exchange for peace of mind that you won’t have any unexpected expenses? Or would you rather pay a lower monthly premium and take the risk that your coverage may require high out-of-pocket expenses should you have a health issue? If you can answer this question for yourself, you’ll give a better starting point to determine what plan/program is a better fit and how much you will spend on said plan.

Make a list of your current medications, dosages, and frequency. After analyzing the entirety of your coverage, the next step would be to write down every medication you take, the dosage, frequency, and brand. This list is going to guide your Part D plan selection.

After completing steps 1-5, set an appointment with a Medicare advisor. After you’ve done the previous five steps, you have painted yourself a pretty thorough picture of your healthcare needs. Now it’s time to take this information to your Medicare advisor, so they can analyze and help you select the best coverage at the best price. Completing steps 1-5 prior to your call or appointment will make the process go much faster and smoother for you. *Helpful Tip: Always work with a non-captive Medicare advisor. They have access to all the plans and companies, not just one of them. This ensures you are in the best plan at the best price.

Remember, in order to ease the confusion, contact a Medicare representative to help make this AEP much smoother. If you don’t have a dedicated agent or aren’t sure, our toll-free Medicare hotline is open for questions, comments, concerns for anyone in the United States who needs consult on their Medicare plans/coverage at (888)-404-5049.

10 Things You Might Not Know About Medicare in the US

We’ve said it before, and we’ll say it again, Medicare is confusing. Which is why we dedicate our lives to helping seniors PREPARE for Medicare before they enroll. Knowledge is power! So with that being said, here is a list of 10 things that you probably don’t know about Medicare, and some of them may surprise you!

Medicare covers more than just senior citizens. Medicare is designed for the aging population, but under certain circumstances, people under the age of 65 can be enrolled. If you have a qualifying disability or End Stage Renal Disease (ESRD), you can get covered under Medicare.
Baby boomers are aging into Medicare at a rate of 10,000 per day. Back when Medicare was first designed, people weren’t living nearly as long as they are today. Add that to the baby boomer generation who are rapidly aging into Medicare at a rate of 10,000 people PER DAY, and you can see how Medicare is quickly going to get into trouble.
Enrollment can happen outside of AEP. There is a common misconception surrounding Medicare that you can’t change your plans unless it’s during the Annual Election Period (AEP) from October 15-December 7. While this is true for Medicare Advantage (Part C) and Prescription Drug Plans (Part D), you can change from Medicare supplement plan to plan anytime you want. There are always “special election periods” and change of status that can warrant a change outside of AEP as well.
Each part of Medicare covers something different. While the parts of Medicare can be the most confusing part, it’s all for good reason. Each part of Medicare means something different and works differently. Part A is for your hospital care, Part B is for healthcare outside of the hospital such as routine doctors’ visits and preventive care, Part C is Medicare Advantage, and entirely different program from original Medicare altogether, and Part D is the prescription drug plan. Every part works differently to make one whole picture.
How much Medicare actually pays out. Medicare supplemental insurance was created to fill in the coverage gaps left behind by original Medicare. Did you know that traditional Medicare only covers 80% of the Medicare-APPROVED costs? That means, YOU as the enrollee are responsible for that other 20%. This is where Medicare supplement insurance comes in. It covers your 20% if you keep up with your monthly premiums, and can save you a ton.
A “non-participating” doctor still takes Medicare. Despite what the status title of “non-participating” doctors suggests, doctors under this status DO accept Medicare. They just don’t accept it at the amount that Medicare pays, meaning these doctors reserve the right to charge the patient additional money on top of what Medicare approves. While it seems confusing, don’t be too alarmed if your doctor becomes a “non-participator”- it just means that they reserve the right to charge you 15% more than Medicare approves. This is typically only found with specialty doctors/treatments.
Waiting to enroll in Part D can cost you FOR LIFE. Once you’ve reached Medicare enrollment time, you also have to enroll in your Part D drug plan. If you don’t, you have to wait until the following AEP, AND Medicare charges a fee every month for the rest of the time you’re on Medicare (aka, the rest of your LIFE!) While the fee is minor, it can add up depending on your lifespan. 1% of the national average in premiums in what you pay PER month, so 12% per year, lasting forever.
Medicare doesn’t cover everything. If you’ve been to your doctor for a physical and you WEREN’T charged for it, your doctor didn’t file it properly. Physicals and some other procedures aren’t covered under Medicare. While Medicare paired with a supplement covers almost everything, and mostly the big stuff, it doesn’t cover everything.
Medicare doesn’t work outside the USA. Getting ready for a big vacation to Europe? Make sure you understand before you go that your traditional Medicare coverage doesn’t apply out of the country. If you have a Medicare supplement, you’re covered. However, traditional Medicare without a supplement or Medicare Advantage does NOT work outside the United States.
On average, with Medicare you get WAY more than you pay for. While your Medicare premiums and co-pays do add up, compared to the average amount of usage, you are saving a TON. Medicare may not be perfect, but it is still possibly the greatest government healthcare coverage known to us. Take advantage of it by preparing yourself properly with a supplement so you don’t get stuck with huge bills, but rather a predictable monthly premium.

It’s true; Medicare is complex. But it’s one of the best working healthcare systems out there, and if used properly it can save enrollees a ton of money in their health care and keep them healthier, longer.

Senior Health Medicare Blog

The best place for Medicare advice, news, and updates