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On Dec. 23, 2020, Congress passed a new provision called the Beneficiary Enrollment Notification and Eligibility Simplification Act of 2020, or “BENES Act” of 2020 as part of the $900 billion pandemic aid package. This bill had wide bipartisan support in the House of Representatives and the Senate. The bill also had strong support from more than 85 national and state organizations that support older adults and people with disabilities. The BENES Act is the first update to Original Medicare (Me...
As you may have known or suspected, Medicare is the largest medical insurance program in the U.S. As of October 2020, there are more than 62.9 million people enrolled in Medicare nationwide, according to the Medicare Enrollment Dashboard. Medicare program costs are evaluated each year and the premiums, deductibles and co-pays are adjusted. Here are some of the changes in Medicare for 2021. Medicare Part A hospital coverage The vast majority of Medicare beneficiaries do not pay a monthly premium...
The Medicare Part D (prescription drug coverage) Open Enrollment Period is now in full swing. (See page 7 for details - Editor.) For those who don’t know, from Oct. 15 to Dec. 7 each year, Medicare provides an opportunity for beneficiaries who have Part A (Hospital) coverage and/or Part B (Medical) coverage to: join a Medicare Part D plan, change their Medicare Part D plan or dis-enroll from Medicare Part D. Enrollment, disenrollment, and plan changes can also be made to Medicare Advantage (...
The summer has flown and autumn is upon us. The leaves on the trees are turning the vibrant colors of fall, and the air is cool and brisk. The captivating smell of fireplaces burning logs permeates the air. It is also the time of year to begin to think about our Medicare prescription drug coverage. From October 15 until December 7, each Medicare beneficiary who part A, Part B, or both has the opportunity to enroll, dis-enroll, or change their prescription drug plan choices. This period is...
Are you restlessly awaiting your Medicare Summary Notice to arrive in your mailbox so you can verify that Medicare paid for a service or product? Are you anticipating the upcoming annual Open Enrollment Period for Part D and want to make sure that your prescription list is current? Have you lost your Medicare card and need to get a new one? Do you want to review what preventive services are available to you? How about getting an “On the Go Report” that summarizes your medical information for you...
Those who are approaching Medicare eligibility, or have Medicare, frequently have many questions - about how Medicare coverage works, enrollment options and costs, and many others. You may ask yourself: “Who do I call?” for answers. The good news is that there are numerous resources out there to assist Medicare beneficiaries with questions or concerns and there is often more than one correct resource. Listed here are some of the agencies that can supply expert knowledge and assistance reg...
Having trouble signing up for Medicare Part B, Medical Insurance, in the midst of these trying times? The Social Security Administration (SSA) is the agency that handles the Medicare Part A and Part B enrollment and as you may know, SSA, like so many other agencies affected by the COVID-19 virus pandemic, has not been open to the public for face-to-face assistance. This has been particularly challenging to people who need to sign up for Medicare Part B, but prefer to do business in person...
During this time of the COVID-19 pandemic, it is a prudent idea to discuss the benefits of having a patient advocate and an authorized representative in the event that you are unable to represent yourself. Patient advocate A patient advocate can be a health care professional or a trusted person, perhaps a relative or friend who can look out for your best interests when you are not well. The advocate’s overall mission is to guide a patient through the healthcare system. Their assistance can i...
The number of diagnosed cases of the coronavirus (COVID-19) has topped 125,000 globally as I write this article. Countries are closing their borders, travel restriction bans into the U.S. are going into effect, and sports leagues have suspended their seasons in an effort to slow the spread of this virus. Some states, such as Alaska have declared a public health emergency status, schools are extending their spring break, some colleges are moving to online classes, and many much anticipated confer...
Often times it can be confusing to Medicare beneficiaries just how much of their medical expenses will be covered and for how much they will be responsible. This, in part, can be due to not understanding their providers’ relationship with Medicare. Medical providers are categorized under three classifications in reference to Medicare. They are: providers who accept assignment, providers who do not accept assignment, and opted-out providers. Providers who accept assignment (also known as p...
You have probably heard, read or seen on the news that there is an opioid abuse epidemic running rampant in the United States. According to the Center for Medicare and Medicaid Services (CMS), Opioids killed more than 47,000 people in 2017. That is 130 people per day. Sadly, 36% of all opioid overdose deaths involved a prescription opioid. It is estimated that three out of four people who used heroin misused prescription opioids first, and over two million people currently have an opioid use...
Each new year is sure to bring changes and Medicare is no different. Here are some changes that you will want to know about. New Medicare cards. Medicare began mailing the new Medicare cards to beneficiaries in April 2018. Up until Dec. 31 of 2019, you could use either your old, Social Security number based card or the new card, which has an 11 character, alpha-numeric identification that is random and yet unique to each beneficiary. As of Jan. 1, 2020, only your new card can be used. So pull...
Have you seen all of the advertising for Medicare Plans? It seems like the TV waves are inundated with commercials about Medicare this time of year. And there is lots of talk about new benefits, free benefits and low or no-cost plans. How do you sort out all of this information and determine what plan is best for you in 2020? Medicare Advantage: Additional benefits, but not offered in Alaska No doubt about it, we are in the middle of the Open Enrollment Season for Part D (Prescription Drug...
What an amazing summer we have had! Now the weather has turned cooler and autumn is definitely in the air. As we plunge into all of the activities of this season, it is important to remember the Part D Open Enrollment Period (OEP) will soon be here. Once again, the Open Enrollment Period will be scheduled between October 15 and December 7. The Part D Open Enrollment Period is the annual opportunity for Medicare beneficiaries with Part D plans to review and possibly change their coverage. You...
Many people are unaware of the many preventive services that are provided to Medicare beneficiaries without paying a single dollar in deductibles or co-pays. Preventive services are covered at 100% under your Medicare Part B benefits and are a great way to get started with utilizing your Part B benefits. This is especially true if you are seeing a new primary care provider. You can begin accessing your preventive benefits by calling your primary care provider and making an appointment to have yo...
Genetic testing has certainly become a phenomenon in the last few years. This amazing new type of medical test, also known as DNA testing, has diverse applications. It can determine bloodlines of familial relationships, can rule out or confirm certain genetic conditions, or determine the likelihood of passing on genetic disorders. There are some conditions or diseases caused by mutated genes that genetic testing can confirm, such as Down Syndrome, Cystic Fibrosis, or Huntington’s Disease. DNA t...
Perhaps your 65th birthday is approaching, signaling that you are approaching your Initial Enrollment Period to sign up for Medicare. Meanwhile, you may be getting postcards and other mail informing you that you need to sign up for Supplemental Medicare or Medigap. You may also be getting phone calls with the same message – that you should purchase a plan right away! What is that all about? There are some people who may not want or need a Medigap plan. For instance, if you will have Medicare a...
Balance billing is when a provider bills you for the difference between the amount he charges for a product or service and the insurance company’s negotiated amount. For example, if the provider’s charge is $100 and the allowed amount or the amount the insurance will cover is $70, the provider may bill you for the remaining $30. This amount can include deductibles, co-insurance and copayments. There are certain Medicare beneficiaries who providers are not allowed to balance bill. This is als...
When we talk about the costs of Medicare, the discussion can include premiums, deductibles, co-insurances and copays. Another cost to Medicare beneficiaries that may come as a surprise is the Income Related Monthly Adjustment, or IRMAA. The IRMAA is an increased amount that individuals who have a higher income pay. This can affect you if your earnings are high or you receive an unexpected windfall such as an inheritance. The IRMAA can affect both your Medicare Part B (Medical) premium and your...
Welcome to 2019! There are a number of changes in Medicare this year of which you will want to be aware. New Medicare cards The New Medicare card mail-out for Alaskans began April 1, 2018 and ended June 30. If you have not received your new card, please contact the Medicare Information Office (800-478-6065) or 1-800-Medicare, so that they can determine why your card has not arrived. It is possible an address update is needed. However, you do not need to panic, as the old card is still usable unt...
You may have seen or heard a lot of buzz about the Open Enrollment Period (OEP) for Medicare Part D. And you may think to yourself, “I am perfectly happy with my current prescription drug coverage and I don’t want to make any changes so I will stay with the plan that I have.” This decision could cost you money and here’s why. The (OEP) is a six week opportunity for those who have Medicare to review their coverage. Persons who have not had prescription drug coverage may join a plan and those w...
Perhaps you have heard advertising that you can purchase back braces, knee braces, and other items with little or no cost to you and that Medicare will pay for them. Let’s get to the truth of these advertisements. First of all – what is Durable Medical Equipment (DME)? DME is defined as equipment that is durable, reusable and is needed to treat an illness or an injury, or to improve the functioning of a malformed body part. These are items that are designed to withstand repeated use. Med...
Although Medicare Part A and Part B cover a wide variety of services and products when you are in the hospital or being seen as an outpatient, there are still cost sharing “gaps”. These include deductibles, coinsurance costs, and copayments. These additional costs can wreak havoc with your finances. Medicare Supplemental Insurance Policies, also known as Medigap policies, are designed to follow behind Medicare Parts A and B to “fill in these gaps” that are left after Part A and Part B have pa...
Each month I enjoy sharing with readers the many facets of Medicare. The enrollment periods, coverage under the different parts of Medicare, types of providers available, how to avoid penalties related to late enrollment, and how to pay for Medicare. However, there are certain services and products that Medicare does not cover under Original Medicare; Part A & Part B, which is what is available to most beneficiaries in Alaska. As you budget your health care dollars, it is important to know what...
Many of you may have heard that there is a new vaccine available for the shingles virus that is proving to be more effective than the previous vaccine, Zostavax. The new vaccine is recommended for people age 50 and older. Called Shingrix, the vaccination does require two doses, the second to be administered between two to six months after the first. Medicare requires all Part D (prescription drug coverage) plans to cover both shingles vaccines. Shingles, also known as herpes zoster, appears as a...
