Category: Medicare Advantage

4 Lightweight Tips to Prevent Medicare Fraud

4 Lightweight Tips to Prevent Medicare Fraud

 

An ounce of prevention is worth a pound of cure. Very few people use this saying anymore, but the truth of it is still relevant—almost shockingly so. Especially when it comes to Medicare fraud.

 

No one wants to be a victim. No one wants to deal with some con down in Florida, racking up charges using their Medicare number. And no one wants to feel taken advantage of.

 

That’s why it’s much better to take the simple steps now. So let’s get started.

 

  1. Protect your Medicare Number!

First things go first. It’s the oldest tip in the book, but it works. This number is unique to you.  So protecting those 9 digits is doubly important: It’s your identity.

 

One way to protect your number is to avoid carrying the actual card unless you have to. And—this almost goes without saying—don’t share it with anyone except your doctor, health care provider, and your insurance agent, who will need it to write a policy.

 

  1. Take a Lesson From Sherlock Holmes.

This sounds like a pound-sized piece of advice, but it’s really not too heavy once you get into the habit. Be like Mr. Holmes and notice the small stuff. Check your Medicare Summary Notice for anything suspicious (i.e. billing to Medicare for care or services you didn’t receive). Check your pills before you leave the pharmacy to make sure everything is correct. Did you get your full prescription?

 

It pays off to notice things that no one else does. It’s elementary, my dear…umm…Medicare beneficiary?

 

  1. Strive to Understand for Yourself.

This is another tip that sounds heavier than it really is. So allow to me translate. For all intents and purposes, this means to ask questions. And I mean a lot of questions.

 

When you don’t understand your bill or your plan or your Medicare options, just ask. Ask your doctor’s office, or ask at your insurance agent’s office.  Shift the weight on the expert to help you understand. If he gives you a boulder-sized answer, give him another boulder-sized question. And don’t let down until you get a manageable answer. This might sound stubborn, but you have a right to know what you want about your health care. It’s the expert’s job to give you an understandable (yet accurate) answer.

 

Because knowing how Medicare works, your plan works, and why you were taken care of the way you were are excellent starting points for noticing and preventing fraud.

 

  1. Don’t go to the mousetrap for the free cheese.

Only a mousetrap has free cheese. This is the truth with all the sales and advertising junk pared away.

 

It’s not that I don’t understand the allure. Someone comes to your door or calls you to offers you something for free. Do you believe it? FREE! All you have to do is give them your Medicare number and then POOF…all your money saving dreams can come true.

 

But don’t fall for it. Don’t go for the cheese. This is a surefire way to get snapped into the metal jaws of Medicare fraud.

 

Stopping Medicare Fraud Ounce by Ounce

In closing, Medicare fraud is a crushing problem. The Medicare Fraud Strike Force is constantly hunting down the bad guys, trying to recover as many funds as they can. But it hardly puts a dent in the 60 billion dollar a year problem, according to AARP. This is why the government needs you to take the necessary measures of prevention. It’s a big problem, but I am confident that if enough people decide to get smart and do these small  “ounce-sized” things now, we can prevent another round of crushing Medicare fraud later.

 

Think you’ve been a victim of fraud? Want to make up to $1000? Then check out this post! 

 

Still have questions?  Call our office at 937-492-8800.  We can help!

CONSUMER ALERT: Seniors Should Beware of DNA Testing Scam

COLUMBUS – Ahead of World Elder Abuse Awareness Day this Saturday, June 15, the Ohio Department of Insurance and the Ohio Department of Aging are warning Ohioans of a new scam targeting seniors. Ohio consumers should be cautious of genetic testing firms visiting senior communities or making unsolicited phone calls and mailings related to DNA screenings.

“Scam artists are always looking for new ways to steal money or personal information,” said Governor Mike DeWine. “We want people to be careful and to know the signs of a possible scam.”

 

In the scheme, which has been reported in Ohio and other states, firms reportedly collect consumers’ personal information under the pretense of DNA testing to screen them for cancer, Alzheimer’s, or other life-threatening diseases. Victims are told that Medicare will cover the cost of their testing. However, Medicare provides limited coverage for DNA testing (which is why consumers should consult their health care providers). As part of the scam, consumers often are asked for their Medicare card number and Social Security number.

 

“We want Ohioans to be aware and cautious as they consider DNA screening services,” said Ohio Department of Insurance Director Jillian Froment. “Consumers should never share their personal information, including Social Security number or Medicare card number, with anyone who reaches out unexpectedly. If you think you may be a victim of fraud or if you suspect potentially fraudulent activity, please contact us.”

 

“Scammers and shady businesses target older adults to steal money, get personal information, or in this case, improperly access individuals’ insurance benefits,” added Ohio Department of Aging Director Ursel McElroy. “As older adults get wiser to common scams, scammers are doing more to try to win their trust. Guard your Medicare or other insurance card like you would a credit card. To a scammer, it is just as valuable.”

 

To protect yourself, be alert if anyone conducting DNA cheek swabs requests that you agree to be billed for services in the event Medicare does not pay. These types of “testers” may be committing Medicare fraud because they are attempting to bill Medicare for a procedure that has not been ordered by a health care provider.

What Should Medicare Recipients Know About Genetic Testing?
  • In order for the testing to be covered by Medicare, it must be medically necessary.
  • Consumers should always confirm that their test has been ordered by their doctor, that it’s covered by their plan, and that it’s medically necessary.
  • If you are interested in DNA screening, talk to your doctor and determine if it is right for you.

How Can I Protect Myself from This Type of Scam?

  • If you or a loved one is approached by someone claiming to offer genetic testing, do not give your personal information (like your Medicare or Social Security information) to them.
  • Theft of Medicare card numbers may be used to commit identity theft or fraud.
  • Instead of receiving a DNA screening unsolicited from a firm not affiliated with your health care provider, talk to your doctor first and determine if the test is necessary.
  • Some consumers have reported receiving DNA testing kits in the mail without requesting them. Consumers should not use these kits but should instead talk to their doctor first.

If you suspect wrongdoing or if you believe you have been victimized, call the Ohio Department of Insurance’s Fraud and Enforcement Hotline at 800-686-1527 or the Ohio Senior Health Insurance Information Program at 800-686-1578.

Older Ohioans and their loved ones can learn more about scams and other forms of elder abuse and exploitation, along with ways to prevent and report them, on the Ohio Department of Aging’s website (www.aging.ohio.gov/elderabuse).

 

Source:  Ohio Department of Insurance

How to Understand Medicare in 3 Simple Steps

How to Understand Medicare in 3 Simple Steps

 

Medicare, like many other government programs, is far from being easy to understand. From family and friends, you get little snippets of guidance, but nothing that gives you a cohesive picture. From the government, you receive the overly exhaustive Medicare & You handbook that is so thick and dry, it might as well come with a “drowsiness may occur” label. And, as for the rest of the Medicare mail, there is little more than ads, ads, and more ads, very few of which offer any more substance other than a quick sales pitch for a Supplement or Advantage Plan (you’ll learn what these are later on). For those approaching 65, understanding Medicare is often daunting.

 

That’s why I am writing this post. I want to help you see your Medicare “big picture.” I’ll try not to go into mind-numbing detail (although I can’t promise this will be evening pleasure reading), and I won’t give you unhelpful bite-sized chunks. You will likely still have questions afterward, but I hope this step-by-step guide helps clears up some confusion about what you will encounter as you make the transition from your private (or employer) insurance to Medicare.

 

If you don’t have time to read this right now, you can call us at 937-492-8800, and we can set you up with a Medicare expert who will walk you through all this information one-on-one.

 

But if you are ready to learn, it’s time to get started.

 

Step #1: Learning the Parts of Medicare

The best way to understand a complex topic is to split it up into parts. Medicare has made this easy for us because Medicare is already made up of four parts: Parts A, B, C, and D. It is essential that you understand them before we go any further.

 

Part A (A.K.A. Inpatient care, A.K.A. Hospital Insurance)

Part A is coverage for care received while officially admitted in at a hospital. Beyond that, it also covers skilled nursing/rehab, hospice, and some home health services. However, for simplicity’s sake, think Part A equals hospital insurance!

 

Part B (A.K.A. Outpatient care, A.K.A. Medical Insurance)

Part B, on the other hand, is the exact opposite, covering care received while checked out of the hospital. So, in a sense, it covers (at least in part) about everything else. This includes diagnostic tests, x-rays, and outpatient surgeries as well as an extensive list of preventative care options. Note that Part A and B together make up what is known as “original” or “traditional” Medicare.

 

Part C (A.K.A. Medicare Advantage)

The C in Part C is for complicated, so I’ve decided to address this later on in the post. For now, just keep it in the back of your mind. This is one of your “2 main options” we will meet again in step 3.

 

Part D (A.K.A Prescription Drug Plan)

The D in Part D is for drugs. In other words, it helps cover the bills for your medications. Part D drug plans are offered by private insurance companies that are regulated by Medicare. Whether or not you need one will be determined by which option you choose in step 3. If you do need one, you purchase it as a stand-alone plan based on your medications and preferences. I recommend using Medicare’s Drug Plan Finder.

 

Step #2: Understanding Signing Up for Parts A and B (Who and When and How)

Now that you have a basic understanding of Medicare’s parts, you should know who should sign up for Parts A and B, when you should do it, and how it is to be done. Let’s start with “who.”

 

Who Should Sign Up?

These two Parts are absolute musts! Everyone should sign up for Medicare Parts A and B eventually. Where situations differ is in the answer to the next question: when?

 

When Should You Sign Up?

Since Part A is free for most everyone, almost everyone should sign up Part A during their Initial Enrollment Period (IEP). The IEP is the seven-month period starting 3 months prior to your 65th birthday month. The only reason you might want to opt of Part A is because of HSA contribution difficulty.

 

Part B, on the other hand, has an associated premium of $135.50 (in 2019). This means if you will continue working and have better value coverage with your employer, it may be a good idea to put off signing up for Part B until you are finished working. Why pay the extra premium if you don’t need to, right?

 

However, you have to be careful with this. If you are going to delay signing up for Part B, you must make sure that you are qualified, otherwise you will incur a penalty. And even if you are qualified, you need to make sure it makes financial sense for you to do so. To give you a quick run down, in order for it to be a good idea to delay Part B, the following three things must be true about your situation:

  • You must have insurance through active employment, not retiree benefits or COBRA. In other words, you must be working (or you spouse must be working if you are covered under their plan).
  • Your employer insurance must cover 20 or more employees.
  • Your employer plan should be a better value than Part B.

 

For more details about whether you should sign up for Part B, click here.

 

If you found that you cannot delay, you must sign up for Part B during the Initial Enrollment Period, just like for Part A.

 

However, if you can delay, you just sign up when you retire. You will likely have a Special Election Period to sign up after your employer coverage ends.

 

How Should You Sign Up?

Unlike the last one, this one is easy and straightforward! There are four ways to sign up for Parts A and B:

  1. If you are already receiving Social Security benefits, it is automatic!
  2. You can sign up online at https://www.ssa.gov/medicare/.
  3. You can call your local Social Security Office.
  4. You can go and visit your Social Security Office for an in-person appointment.

Once you’ve signed up, expect your Medicare card to come in the mail soon after. Not too difficult, right?

 

Step #3: Understanding Your 2 Main Options

After figuring out the who and when and how of signing up for Parts A and B, this is where you have to make a big decision. It is here where the Medicare trail diverges into three possible paths:

  1. You could go with Original Medicare (Parts A and B) alone.
  2. You could pair a Medicare Supplement with Original Medicare.
  3. You could go with a Medicare Advantage Plan (Part C—I told you we’d meet him again).

 

I promise I can count (I’d be in bad shape as a financial planner if I couldn’t). The reason why it says there are only 2 options in the heading is because, although a very choice few disagree, most do not believe option #1 to be viable at all. Allow me to explain why:

 

Original Medicare Alone Leaves Some Potentially Devastating Gaps!

Parts A and B alone do not cover everything. For Part A, you have a $1,364 deductible that you may have to meet more than once per year and limited to no coverage for extended hospital stays. And for Part B, you have a 20% coinsurance on all outpatient services. And these are just a couple of the many costly gaps!

 

To give you an idea of what this might cost you, this means a 120-day hospital stay would be over $31,000! And if you have outpatient chemotherapy and radiation like my father-in-law, you could wind up being on the hook for over $30,000 that Part B won’t cover! Since there is no out-of-pocket spending cap with Medicare alone, there is no limit to what you might spend.

 

With that being said, I strongly recommend choosing one of the other two options (you can’t choose both). As the last part of our last step, we will look at what sets these two apart and outline some of the strengths and weaknesses of each.

 

What’s The Difference?

Medicare Advantage plans should be seen as an alternative to Original Medicare offered by private insurance companies that provide coverage that is at least as good as Medicare. Although you still have to sign up for Parts A and B, if you sign up for Medicare Advantage, the private insurance company will REPLACE Medicare as the payer of your claims. But you will still pay the Part B ($135.50 for 2019) premium each month.

 

A Medicare Supplement, on the other hand, pays SECONDARY to Medicare. Medicare pays what it normally pays for, and then the Supplement swoops in to pay your share of the costs (i.e. those gaps we talked about earlier such as 20% on outpatient services).

 

What Are The Strengths And Weaknesses of Each?

To put it simply, the Medicare Advantage Plan wins at cost effectiveness. As an in-the-ballpark figure, an Advantage Plan will cost you about $60 per month on average. Some are even $0 premium plan! A Supplement, on the other hand, will cost an average of about $110 per month. In addition, an Advantage Plan almost always has a built in drug plan, while you will have to buy a stand-alone drug plan if you have a Supplement, which (depending on your medications) is about an extra $35 per month.

 

However, a Medicare Supplement wins at just about everything else. They cost you less in out-of-pocket expenses throughout the year. Their benefits package is much more stable every year. You have more freedom to choose healthcare providers, and you are more likely to have out-of-state coverage.

 

For a more in-depth look at the pros and cons of these two options, click here.

 

When it comes to deciding, it is all about what is important to you. For instance, if you travel a lot, out-of-state coverage may be very important to you. Therefore, you may want a Supplement. However, if you are more cost-conscious, an Advantage Plan might be the best. It’s all about finding the best plan to meet your unique needs and preferences.

 

Retiring soon and don’t know what to do? Call us at 97-492-8800 to discuss your options. No high-pressure sales pitches here, just in-depth discussion about the ins and outs of Medicare!

 

Can I Really Get a Medicare Advantage Plan For Free?

Can I Really Get a Medicare Advantage Plan For Free?

Yes, for quite a few Medicare Advantage plans, you will not have to pay a dime in premiums. And to sweeten the deal, you can even get extra benefits like gym memberships or a built in drug coverage with some plans. But I’m very stingy with my use of the word “free.”

 

From my experience, an Advantage Plan is free in the same way the newborn puppies of your best friend’s dog are “free.” You may not have to pay for the puppy, but how many know having man’s best friend around the house isn’t exactly a recipe for super savings (especially if you’ve got furniture and footwear that look especially appetizing in black and white)?

 

You see, a Medicare Advantage Plan might not cost anything in premiums, but it may eat up your money in the end. I’m not saying they aren’t right for some people, in fact; I’ve placed people in $0 Advantage Plans to their long-term satisfaction. For the cost-conscious retiree who is romping into retirement, healthy as a horse, it may be the best option. But before you purchase one, make sure you understand the hassles and extra costs that come along with the decision. I’ve outlined a few of the most important ones:

 

Networks

Advantage Plans have networks of health care providers that they have contracted with, usually within a fairly tight geographic area. If you do not receive care at one of their pre-picked providers, it can mean much higher co pays and coinsurance amounts. If you are in an HMO plan, they may not even cover you at all while receiving care out of network. This can work just fine for a person who stays local most of the year, but it does put the burden on you to ensure that your health care provider is in-network. Making mistakes could cost you heavily.

 

Inconsistency

With a Medicare Supplement, the benefits are stable, but with an Advantage Plan, this is hardly ever the case.

 

Since the private insurance companies that offer Advantage Plans re-file their contract with Medicare every year, the benefits always change—sometimes dramatically. One of your preferred doctors could go out of network. Co payments, coinsurance, and deductibles can all shoot up. This is why you must review your plan every year so you won’t be caught unaware. If you set your plan to the side and forget about it for even one year, it can be quite upsetting financially.

 

Potentially High Out-of-pocket Costs

I always like to remind people that Advantage Plans have more of a “pay as you go” approach. You pay less in premiums, yes.  But you may make up for it in deductibles, co payments, and coinsurance. For example, almost all Advantage Plans still keep you on the hook for the 20% coinsurance on Part B. That’s fine for an x-ray, but not as much for an outpatient surgery that may be $20,000 or more.

So be aware, Advantage plans do limit your annual out-of-pocket spending, but these caps are generally pretty high. If you have a period of extended illness, you could spend anywhere from $3500-6000 per year or more!

 

That doesn’t sound like free to me.

 

That is why you need to be wary of salespeople who may just be trying to convince you to switch to a Medicare Advantage Plan this Annual Enrollment Season. It may be right for you, but—then again—it may cost you a lot more in the long run.

 

Looking to review your plans with a Certified Senior Advisor this Annual enrollment season? Call Seniormark at 937-492-8800 or click here to set up a free consultation.

 

Is There an Advantage to Medicare Advantage?

Is There an Advantage to Medicare Advantage?

According to Reader’s Digest, 1 in 4 retirees receive their health insurance coverage from a Medicare Advantage Plan. And I can certainly understand the attraction. Premiums as low as $0 a month. Prescription drug plans often included. What’s not to like?

 

But—as it goes for most purchases—you get what you pay for. And when it comes to Medicare Advantage Plans, they definitely have a dark side. Allow me to shed some light on the subject.

 

The Medicare (Dis)Advantage Plan

Networks

Medicare Advantage Plans contract with specific hospitals and doctors, usually within a relatively tight-knit geographic area. If you don’t receive care from the ones with whom they’ve “networked”, you may be subject to higher co pays or coinsurance at each visit.  Depending on the plan, they may not even cover your expenses at all.

 

This can be a problem for anyone, but especially for those who travel frequently. So for you snowbirds out there who fly south for the winter and leave us all to freeze, this serves you right (forgive my jealous outburst). You may find yourself with less (or even no) coverage at your vacation home. Although they will still cover you in emergencies, that doesn’t mean it won’t be an expensive hassle.

 

Inconsistency

Because Medicare Advantage Plans are funded by government subsidy, the cost and benefits can change drastically from year to year. If the government decides to spend your tax dollars elsewhere, your plan may let prices creep (or even leap) up, while benefits wane. This all depends on politics, which—as you already know—is rarely consistent.

 

Potentially High Out-of-Pocket Costs

Medicare Advantage Plans have more of a pay-as-you-go approach. Although the premium is low, deductibles, coinsurance and co pays are often much higher. This is not a problem if you are healthy, but if you are struck with sudden illness, you might be stuck with astronomically high out-of-pockets: $3,500 to $6000 a year or more! And if the diagnosis is bad enough, you may not qualify to switch to a Supplement plan.

 

Let’s take a real life example.

A client of ours came in with an Advantage Plan. He was diagnosed with cancer in fall of 2012 and started chemotherapy immediately. Since he was in charge of 20% of the costs due to his plan, he very speedily met his $7,500 annual out-of-pocket limit. Then it was the New Year, and his out-of-pocket limit reset. He continued chemo-treatments, which lead to another $7,500 expense. That is $15,000 of spending in less than 6 months!

 

And since a cancer diagnosis prevented him from switching to a Supplement, he had to stay with his Advantage Plan. He was stuck, and—needless to say—very unhappy about it.

 

So Here’s the Bottom Line…

Is there an advantage to a Medicare Advantage Plan?

If your doctors are in your plan’s network, you stay on top of changes, and—here’s a big one—you don’t get horribly ill (leading to high out-of-pocket costs), then yes! The Medicare Advantage dark side has vanished. The force is with you, and you’ve saved hundreds or even thousands in premium costs.

 

But you need to assess your situation. You need to take the risk into consideration. 1 in 4 people might be on a Medicare Advantage Plan, but that doesn’t mean it is right for you!

 

Looking to switch to or purchase a Medicare supplement? Call Seniormark at 937-492-8800 for a free consultation. We are here to help.

Why You Can Try a Medicare Advantage Plan at No Risk

Why You Can Try a Medicare Advantage Plan at No Risk

 

Infomercials have done it for years.  When people feel uneasy about trying a new product, they offer a free trial or a money back guarantee.  It provides security for the buyer to know that even if the supposed benefits of a product were oversold or blown out of proportion, he can still send it back.  There’s no risk.

 

Well, Medicare offers something very similar.  It’s called the “Medicare Advantage Trial Right”.

 

A lot of people are uncomfortable with trying Medicare Advantage because they don’t want to feel trapped in a plan they hate until the next Annual Enrollment Period.  The trial period takes this risk away.  As long as it will be your first time enrolling in a Medicare Advantage Plan, you qualify for Medicare Trial Right!  This means that—no matter what time of year it is—you can drop your Medicare Advantage plan with no penalty and enroll in a Medicare Supplement Plan.  This “free trial” period lasts 12 months from the date the Advantage Plan coverage goes into effect.

 

But as the infomercial cliché puts so obnoxiously…

 

 WAIT…There’s More!

 

Some people believe that if they have pre-existing conditions and get on an Advantage Plan, they will be denied switching back to a Medicare Supplement Policy based on their health.  In other words, they think that if they give up their Supplement for an Advantage Plan, they will never get it back.  But that’s where the “money back guarantee” part of the deal comes in.  Regardless of health, the Medicare Trial Right guarantees that you will be able to get back on a Supplement, no medical underwriting involved.

 

It’s true that Medicare Advantage plans are alluring with their sometimes shockingly low premiums.  But they aren’t always the right (see here for related article) fit for retirees.  They change unpredictably and can be quite a hassle.  This is why the Trial Right is so beneficial.  It allows you to try a plan on for size, and then toss it back on the rack.  To test drive it around the block, and then park it in the lot if it doesn’t meet your standards.  And all the while, it guarantees that your old, trusty Medicare Supplement will be there.

 

Want to look into switching to a Medicare Advantage Plan?  Call Seniormark at 937-492-8800 for a free consultation.

Don’t “Set It and Forget It” This Annual Enrollment Season!

Don’t “Set It and Forget It” This Annual Enrollment Season!

Does anyone remember Ron Popeil?  If you don’t, allow me to rephrase the question.  Does anyone remember the “set it and forget it” infomercial king?

 

I bet it’s ringing a bell now.

 

I, for one, can still see him in his green apron, armed with nothing but some well-seasoned meats and a fancy rotisserie cooker, taking the cheesy and overly scripted infomercial world by storm: “All you have to do is…”  The unrealistically enthused audience chants, “SET IT AND FORGET IT!”

 

He was like the Billy Mays of the 70s, but with food instead of cleaning products.

 

But I digress…back to the topic at hand.  The reason I retrieved this slogan from memory lane is to make a point: Many people have the “set it and forget it” mindset with their Medicare Health Insurance Plans.  They think that once they undergo the process of enrolling in Medicare, enrolling in supplemental coverage or an Advantage plan, and signing up for a drug plan that they never have to change anything again.  Happily ever after.

 

But this just isn’t true.  Yes, most of the work is done.  And you’ve definitely done the minimum to get by.  But there’s a good chance your situation will change over time.  And, even if your situation doesn’t change, there is a very good chance your health care plans will, oftentimes drastically.  This leaves you in an ill-fitting plan that doesn’t meet your needs or your budget.  You may need to switch!

 

When it comes to Medicare Annual Enrollment, there is a reason for the season.  From October 15—December 7, you have the opportunity to make strategic changes to your health care plans.

 

Here are 3 reasons you might need to make changes this year!

 

The Medicare Supplement Creep

Medicare Supplements are typically consistent from year to year.  The benefits are guaranteed to stay the same, and the premiums rarely increase drastically.  But the premium cost almost always creeps up, dollar by dollar, slowly but surely.

 

If you stay on that ride for too long, you could end up paying $100+ more a month than you should.  In fact, if you have been in the same Medicare Supplement Plan for 4-5 years, there’s a good chance you’re paying too much for it.  Shopping around for a better deal this year could save you hundreds…and all without reducing your coverage.

 

REMINDER:  You can change your Medicare Supplement any time of year (click here for related info), not just annual enrollment.

 

The Advantage Plan Leap

There are so many aspects of an Advantage Plan that can frog around over time.  The deductible may go up.  The premium may go down.  You might have higher copays.  Your coinsurance might drop.  And beyond benefits and price, doctors and hospitals may go in and out of your plan’s network.  A doctor available to you this year, may not be available the next.

 

This is why it is important to review your plan.  Is your family doctor still within the plan’s network?  Is it still the best value for you?  If you simply set it, forget it and let it skate by another year, you’ll never know.

 

The Drug Plan Drop

A drug plan may vary in cost from year to year, but what you really need to check is the list of medications the policy covers, also known as the formulary.

 

Over the years, a drug plan may discontinue or reduce coverage on certain medications.  Imagine if the drug it discontinued was your most expensive one, and you didn’t realize it.  Yeah…it could be a financial disaster.

 

Review Your Plan This Year!

So make sure to take control of your health insurance options.  Review your plans, and take careful note of all the changes.  The “set it and forget it” philosophy might work well for cooking chickens, but it doesn’t work for this.

 

For your health insurance, I offer another slogan:  If you set it and forget it, you might regret it.

 

Maybe that will catch on…

 

Yeah…probably not.

 

Looking to review your plans with a Certified Senior Advisor? Call Seniormark at 937-492-8800 for a free consultation.

A Little Known Reason Why Medicare Will Deny Coverage For Your Nursing Home Stay

A Little Known Reason Why Medicare Will Deny Coverage For Your Nursing Home Stay

There are few things more wrinkle-inducing than the stress of any unexpected bill, let alone a $6000-8000 nursing home expense left uninsured by Medicare.

 

But it happens everyday. If you receive only custodial care at the nursing home, Medicare will not cover you.  (Read this blog for a few answers.)   And even if you are receiving skilled nursing care, there is still a chance you won’t be insured.

 

Here’s the reason: Many people don’t receive 3 days of inpatient care before moving onto the nursing home. This is a requirement for coverage!

 

Check Your Status!

What really throws people for a loop is that not all hospital stays qualify as the required inpatient care. So even if you stay a week in the hospital’s luxurious half-room with a moaning mystery patient on the other side of the curtain, that doesn’t mean you satisfied the requirement (even though you definitely earned it, in my opinion).

 

Why, you ask?

 

It has to do with your official status. Some people are formally checked-in, but others are filed under “observation status”. In other words, they are not receiving any specific treatment but are rather checked in for the purpose of evaluation, testing, and monitoring. In almost all respects, they receive similar care to those who are formally checked in, but these patients are billed and covered like they are receiving outpatient services. They don’t fulfill the 3-day inpatient requirement and—when they move on to a skilled nursing facility like a nursing home—they are denied coverage when they need it most.

 

Sounds a bit unfair, right? I agree wholeheartedly. Luckily, the government is aware of the issue and is taking steps to resolve it.

 

Baby Steps

One of these small steps occurred in August of 2015 when Obama signed the Notice of Observation Treatment and Implication for Care Eligibility Act. I know—legislators have a knack for snappy titles. But in all seriousness: What the article lacks in creativity, it makes up for in functionality. This Act requires hospitals to alert you of your observation status and how it will affect your Medicare coverage in both writing and in person.

 

Potential Strides

The Notice Act doesn’t solve the whole issue, of course. It would be better to just allow all hospital stays to count toward the 3-day inpatient requirement. The good news is—yet again—politicians are working toward this.

 

But until then, be aware and ask about your status.  It pays to be educated. And it can save you an arm and a leg to know what others don’t and what hospitals neglect to tell you.

 

Turning 65 soon and confused about Medicare?  Call Seniormark at 937-492-8800 or click here to sign up for a free consultation!

Watch Out for Medicare Scammers as New Medicare Cards are Issued

Watch Out for Medicare Scammers as New Medicare Cards are Issued

If you have read any of my other blog posts detailing the evils of Medicare fraud, then you know what a pervasive and serious problem it is. Not only does it cost Medicare recipients and taxpayers such as yourself millions in false claims, it can also cost lives in some rare cases due to malpractice and misdiagnosis.

 

This is why the Center for Medicare and Medicaid Services (CMS) launched an initiative to help tackle this complex problem. It is called the Social Security Number Removal Initiative (SSNRI), which accomplishes almost exactly what it sounds like it does. The measure ensures that Medicare will issue new Medicare cards to over 57 million enrollees with (you guessed it) the Social Security numbers removed. Instead the card will proudly display a new identification number called the Member Beneficiary Identifier (MBI). Medicare hopes that, with such an important number replaced on the card, it will make it more difficult for the bad guys to steal your precious identity.

 

However, the reason why I am alerting you of such a change is because the Better Business Bureau predicts that, scammers will prey on the uncertainty of this transition in the form of phone scams, and I do not want you to be a victim. Over the period of April 1, 2018 to December 31, 2019, be on special guard against these kinds of attacks. Knowing how this initiative will take place will help keep you safe. Therefore, keep the following things in mind about the SSNRI:

  1. You will not need to pay for your new card. If someone claims you have to, it’s a scam.
  2. You will not need to share your Social Security Number over the phone either. Reminder: Medicare will not call you or ask for personal information over the phone.
  3. You will not lose your Medicare Coverage in this transition. If anyone threatens this if you do not give them your information, it is a scam as well.
  4. This process is entirely automatic! Your new card will just show up in the mail sometime between April 1, 2018 and December 31, 2019.

 

It’s certainly frustrating that scammers can take an initiative designed to stop them and use the process as an opportunity to trick even more people. However, once you have your new Medicare card in hand, it will make it even more difficult on them. And, as long as you remember those four points, you will keep yourself safe in the transition as well.

 

Did you know that if you have been in the same Medicare Supplement for 4-5 years, you are likely overpaying for your coverage?  Click here to find out how much you could be paying:  https://seniormark.com/resources/#medicare-rate.

 

Want more information?  Contact our office at 937-492-8800 or via e-mail at admin@seniormark.com.  We are here to help!

2018 Medicare Parts A & B Premiums and Deductibles Announced

2018 Medicare Parts A & B Premiums and Deductibles Announced

 

Yesterday, the Centers for Medicare and Medicaid Services (CMS) released the 2018 premiums for the Medicare inpatient hospital (Part A) and physician and outpatient hospital services (Part B) programs.

For 2018, the Part B premium will be $134 for those new to Medicare.  For those already on Medicare, their premium will be between $108-$134, depending on the amount of their social security cost of living increase.  The Part B deductible will remain the same ($183). There are some changes to the numbers which are listed below, but if you have a Medicare supplement policy, it will take care of some, if not all, of these expenses.
2017                     2018
Part B Premium                                              $109.00                $134.00
Part B Deductible                                           $183                     $183
Part A Hospital Deductible                             $1316                   $1340
Part A Hospital Coinsurance Days 61-90        $329/day          $335/day
Part A Hospital Coinsurance Lifetime Reserve Days
$658/day          $670/day
Skilled Nursing Coinsurance Days 21-100
$164.50/day      $167.50/day

For more information on the 2018 Medicare Parts A and B premiums and deductibles, please contact our office at 937-492-8800.