April Monthly Medicare Message

Prescription Medicare Part D (prescription drug coverage) is available to everyone with Medicare. Private companies provide this coverage. You choose the Medicare drug plan and pay a monthly premium. Each plan can vary in cost and specific drugs covered. If you decide not to join a Medicare drug plan when you’re first eligible, and you don’t have other creditable prescription drug coverage, or you don’t get Extra Help, you will likely pay a late enrollment penalty.

For Medicare assistance, please call SeniorsPlus at 207-795-4010.

A Medicare NuggetFebruary 23, 2017

(from Stan Cohen for The Bridgton News) — One of the ideas that Congress has been considering in its effort to control the costs of Medicare, is to raise the age of eligibility.

The National Committee to Preserve Social Security and Medicare Foundation and the Actuarial Research Corporation (ARC) recently released a new study on the impact of raising the eligibility age for Medicare from 65 to 67.

According to ARC projections, if Medicare eligibility is raised to age 67 and the Affordable Care Act (ACA) remains in effect, by 2019 the percent uninsured among those aged 65 and 66 will increase more than nine-fold, from less than 2% to 18.7% (1.9 million people).

If the ACA is repealed, and that fight is evidently not over, the uninsured rate would then increase to 37%. That is more than one-third of those 65 and 66, affecting 3.8 million seniors.

According to the report, raising the Medicare eligibility age would likely result in people ages 65 and 66 forgoing needed care. As a result, those who forgo care could experience worsening health outcomes and create higher expenses for the Medicare program when they are finally eligible.

It is fair to conclude that raising the Medicare eligibility age would have a profound impact on the health and financial stability of near retirees. It would, in all likelihood, cost taxpayers more in the long term.  

For more information or assistance, please call SeniorsPlus at 207-795-4010. 

March Monthly Medicare Message

Prescription drugs play an important role in treating many conditions and diseases, but when no longer needed, they are not safe to keep in your home. Proper disposal of medication:

• Keeps you from taking the wrong medicine or an expired one.

• Protects children and pets from poisoning.

• Discourages misuse or abuse of prescription drugs.

Keeping unused prescriptions in your house can be dangerous! 

A Medicare NuggetFebruary 23, 2017

(from Stan Cohen for The Bridgton News) —  What is the “Donut Hole” in Medicare Part D?

1. Starting on Jan. 1 Mr. Dill pays the first $400 for his medicines before his plan starts to pay its share. That is his plan’s deductible. Some plans have no deductible.

2. Following the deductible period Mr. Dill pays a co-payment when he buys his medicines (the co-payment may be zero for some generics in some plans). His plan pays the rest. This is called the INITIAL COVERAGE PERIOD.

3. If and when Mr. Dill’s share, plus the amount paid by his plan, reaches a total of $3,700, he enters the coverage gap (the donut hole). In 2017, while in this “gap” period, he will pay 40% of the cost of brand name medicines, and 51% of the cost of generics. Also during this period, the total cost of the drugs he buys counts as out-of-pocket spending which may help him get out of the donut hole.

4. If and when Mr. Dill has spent $4,950 out-of-pocket (counting from Jan. 1 and not including the monthly premium), he will enter the so-called CATASTROPHIC period – and will pay only a small co-payment for each drug until the end of the year. Otherwise, he will continue in the donut hole until the end of the year.

The good news is that, because of a rule in the Affordable Care Act (Obamacare), the Part D coverage gap will vanish in the year 2020.

For more information or assistance, please call SeniorsPlus at 207-795-4010.

February Monthly Medicare Message

If you have Medicare, you’ll get an Explanation of Benefits and/or a Medicare Summary Notice each month for any services, supplies, equipment, or medications you received during that month. Please review it carefully. If you notice any discrepancy, please contact your provider immediately. If, after contacting your provider, you are not satisfied with their response, contact us and we will assign a Medicare Advocate to assist you in resolving the issue.

A Medicare NuggetJanuary 26, 2017

(from Stan Cohen for The Bridgton News) — One of the unfortunate myths that has been circulating (during the 2016 presidential campaign, and since), is that Medicare is going broke! Medicare is NOT imminently running out of money. That myth has been debunked over and over again, but the forces that want to restructure Medicare into a voucher program keep promoting the fiction in order to support their agenda.

One of the most respected and non-partisan research groups in America is the Center on Budget Policy Priorities (CBPP). It is a non-profit organization funded by grants from foundations, many of which are republican based. The CBPP Trustees write: “Medicare’s Hospital Insurance trust fund (HI) will remain solvent – that is, able to pay 100% of the insurance coverage it provides – through 2028. Even after 2028, when the HI trust fund is projected for depletion, incoming payroll taxes and other revenue will still cover 87% of Medicare hospital insurance costs.” Furthermore, CBPP has identified several solutions to closing the gap after 2028.

Another common myth: The Affordable Care Act (ACA) is causing Medicare to go broke. In fact, the opposite is true. According to CBPP, the ACA and other factors have significantly improved the financial outlook for Medicare. Those of us on Medicare or soon to be on Medicare, therefore, should encourage our federal legislators to back-off their efforts to gut the ACA.

January Monthly Medicare Message

Medicare covered preventive services: An easy New Year’s resolution to make and fulfill is to schedule your free Medicare Annual Wellness visit. This visit is covered once every 12 months if you have had Part B for longer than a year.

When you make the appointment, make sure you specify that it is your “yearly wellness visit.” This gives you an opportunity to spend quality time with your primary care physician. It’s a visit to talk about your health and develop a personalized prevention plan. 

A Medicare NuggetDecember 29, 2016

(from Stan Cohen for The Bridgton News) — Would you like to look up your own history of Medicare claims and payments? You can do that and you can also view the following information about your Medicare preventive services:

• “Two-Year Calendar of Current and Upcoming Preventive Services,” which show the services for which you are eligible in the current and following year.

• “You are Eligible for These Services Now,” which list all preventive services available to you immediately.

It isn’t difficult to get started. You need only set up, online, a personal, private account with Medicare. If you don’t have a computer of your own, most town libraries offer the use of computers and assistance in using them.

Begin by logging on to www.MyMedicare.gov and click “create an account.” Then register with a user name and password. This is a great way to make sure that all health-related charges made on your behalf to Medicare are, in fact, accurate. It also serves as a reminder of which preventive services you should consider asking your doctor about -- and it’s free.

Medicare questions? Need help? Call 1-800-427-1241.

December Monthly Medicare Message

You can switch from your Medicare Advantage plan to Original Medicare during the Medicare Advantage Disenrollment Period, January 1 to February 14, 2017.

If you have a Medicare Advantage plan you will be able to switch to Original Medicare with or without a stand-alone prescription drug plan. Changes made during this period will become effective the first of the following month. Please contact us at 1-800-427-1241 or 207-795-4010 if you have any questions.

A Medicare NuggetNovember 28, 2016

(from Stan Cohen for The Bridgton News) —  The basic Medicare Part B premium will increase 10% in 2017, but about 70% of Medicare beneficiaries will see only a relatively small increase in their Part B premium – from $104.90 to about $109. That is because the law contains a “hold harmless” provision that limits the dollar increase in the Part B premium to the dollar increase in an individual’s Social Security benefit.

But what’s going to happen to the 30 percent of beneficiaries not protected by the hold harmless provision? These include new enrollees during the year 2017; enrollees who do not receive a Social Security benefit; enrollees with high incomes (they are subject to the income-related premium adjustment); and dual Medicare-Medicaid beneficiaries, whose full premiums are paid by state Medicaid programs. Many in these categories will pay the new premium of $134.00 – up from $121.80 in 2016. On the other hand, those who first claimed Social Security benefits in 2016 and are paying $121.80 now, won’t pay more in 2017 than $134, or $121.80 plus the dollar increase in Social Security benefits they receive in 2017 (whichever is less).

Reminder: The open enrollment period for Medicare Part D and Medicare Advantage plans ends on December 7th.

Disclosure: Some of the text in this Nugget was borrowed from an article by Alicia H. Munnell, published in Market Watch.  

What is a Medigap policy?

The Medicare Rights Center answers this question: "I am turning 65 soon and am confused about supplemental health insurance. I see so much advertising about these plans, but what are they and do I need one?"

November Monthly Medicare Message

Medicare fraud: Protect your Medicare number and Social Security number from fraud by treating them like they are credit cards. Don’t ever give them out except to your doctor or Medicare provider. Never give your Medicare number in exchange for free medical equipment or any other free offer. Dishonest providers can use your numbers to get payment for services they never provided.  

Please contact SeniorsPlus if you have any questions about Medicare fraud at 1-800-427-1241.

October Monthly Medicare Message

Medicare Open Enrollment is held from October 15th through December 7th for Medicare Parts C & D.

Medicare plan benefits and your needs change every year, so this is your opportunity to compare your options and get the right plan for you. SeniorsPlus provides unbiased expertise to review your current prescription drug plan. There is no charge for this service. Donations are appreciated.

An appointment is need to ensure we have time to meet with you. Call us at 1-800-427–1241 to schedule one. 

September Monthly Medicare Message

A Medicare Advantage Plan (like an HMO or PPO) is another way to get your Medicare coverage.

If you join a Medicare Advantage Plan, you still have Medicare. You’ll get your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage from the Medicare Advantage Plan, not Original Medicare. Most plans include Medicare prescription drug coverage (Part D). Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by private companies that Medicare approves.

Please contact SeniorsPlus at 207-795-4010 if you have any questions about Medicare Advantage Plans.  

A Medicare NuggetAugust 24, 2016

(from Stan Cohen for The Bridgton News) —  According to Susan Jaffe, a writer for Kaiser Health News, “With Medicare’s specific approval, a health insurance company can automatically enroll a member of its marketplace or other commercial plan into its Medicare Advantage coverage when that individual becomes eligible for Medicare.” The insurance industry calls that called “seamless conversion.” I call it abusive corporate behavior even though it is legal.

Although the process requires the insurer to send a letter explaining the new coverage, many beneficiaries don’t read those kinds of letters, or don’t understand them. Although a person who is auto-enrolled in a Medicare Advantage plan can opt out, attorney David Lipschutz (Center for Medicare Advocacy) says giving beneficiaries the chance to opt out “doesn’t adequately safeguard consumers. An insurer’s notification letter can easily be mistaken or overlooked in the deluge of marketing materials seniors receive.”

Some seniors would choose traditional Medicare coverage rather than Medicare Advantage (or a different Medicare Advantage plan) if they knew they had choices. This exploitative auto-enroll practice should, in my opinion, be outlawed by the Center for Medicare and Medicaid Services.  

August Monthly Medicare Message

If you have Original Medicare, your doctor, other health care provider, or supplier may give you a notice called an Advance Beneficiary Notice of Non-coverage (ABN). This notice says Medicare probably will not pay for some services in certain situations.

All doctors must use the Medicare approved ABN, which provides you with an estimate of the cost of the treatment if Medicare does not pay for it. This notice gives you the option to choose whether or not you want your claim submitted to Medicare. It is wise to have your doctor submit the claim to Medicare, as Medicare may pay for the services or items. Please call us at 207-795-4010 if you have any questions.  

A Medicare NuggetAugust 1, 2016

(from Stan Cohen for The Bridgton News) — There are several programs available to assist low-income seniors with health coverage. Examples: MaineCare, Medicare Savings Program, Low Cost Drugs for the Elderly, Maine Rx Plus, Federal Low Income Subsidy for Part D, and pharmaceutical company Patient Assistance Programs. Even many hospitals have “free care” policies for those who are really needy.

I suspect that one reason why many eligible seniors do not enroll in these programs is that Mainers are proud, self-reliant people. These are admirable qualities. In most cases, however, an eligible person has already helped to pay for the assistance program through income taxes. It is, therefore, not a “hand-out”. They should, in my view, not let pride get in the way of taking care of themselves.

Think of it this way. The healthier you can stay, the less you become a burden to yourself, your family, and to your community. So, in a very real way, each eligible person who applies for assistance from one or more of these public programs is doing everyone a favor. 

A Medicare NuggetJuly 14, 2016

(from Stan Cohen for The Bridgton News) — The Trustees of the Medicare Trust Fund, the fund that finances Medicare’s hospital insurance coverage, projected in June that Medicare Part A will remain fully funded until 2028, 11 years longer than they projected in 2009 but slightly shorter than projected a year ago.

“Cost growth per beneficiary continues to be exceptionally low,” said Andy Slavitt of the Centers for Medicare & Medicaid Services, “and over the next decade, per-enrollee Medicare spending growth is expected to continue to be lower than the growth in overall per capita national health expenditures.” That’s the good news.

But not all is rosy. The Medicare Trustees noted that the growth in the costs of prescription drugs paid by Medicare continue to exceed growth in other Medicare costs. MedPAC, the congressional agency charged with making regular recommendations on Medicare, said spending for Medicare's prescription program (Part D) grew by nearly 60 percent from 2007 through 2014, from $46 billion to $73 billion. That is unsustainable. One measure that could mitigate this seemingly out-of-control spending on drugs is to give the administration the authority to negotiate drug pricing for Medicare Part D. Just like the V.A. does. A similar plan has been submitted to Congress more than once – and has been defeated each time. Guess who is doing the lobbying. 

A Medicare NuggetJuly 7, 2016

(from Stan Cohen for The Bridgton News) —  Remember the “doc fix” crises? For several years congress made annual, temporary adjustments to the way Medicare paid doctors so that payments to physicians wouldn’t fall of the proverbial cliff. Then came the Medicare Access and CHIP Reauthorization Act of 2015 which essentially ended the year-to-year problem. That legislation also made numerous improvements to our health care system, including payments based on value rather than on volume.

The way Medicare currently measures the quality of care provided by clinicians depends on which of six “Alternative Payment Models” they are participating in. These various programs will now be integrated into a single framework to help doctors transition from payments based on volume to payments based on value. “It will improve the relevancy and depth of Medicare’s quality-based payments and increase clinician flexibility by allowing clinicians to choose measures and activities appropriate to the type of care they provide”. We’re getting there – be patient. 

A Medicare NuggetJuly 5, 2016

(from Stan Cohen for The Bridgton News) — Remember the infamous “doughnut hole” in Medicare Part D? Well, it is going to be with us for three and a half more years. This coverage gap kicks-in when drug purchases under Medicare Part D (computed from January 1) reach a certain dollar level. This year, that level is $3310 and includes both the buyer’s co-pays and the contributions from the plan. The good news is that, because of provisions in the 2010 Affordable Care Act, big discounts apply to drugs bought during the coverage gap. And these discounts increase each year:

Year Brand name drugs Generic drugs

2016 55% 42%

2017 60% 49%

2018 65% 56%

2019 70% 63%

2020 No more “doughnut hole” 

Medicare Volunteer Counselors are available for one-on-one consultations at no charge. 

July Monthly Medicare Message

Durable Medical Equipment: Did you know that Medicare Part B covers durable medical equipment (DME) that your doctor prescribes for use in your home?

• Anyone with Medicare Part B is eligible.
• Generally, you pay 20% of the Medicare-approved amount after you have met your Part B deductible for the year. The amount you pay may vary depending on the kind of DME needed.

If you have questions about the cost of durable medical equipment or coverage, call 1-800-MEDICARE or call SeniorsPlus at 1-800-427-1241.  

A Medicare NuggetJune 28, 2016

(from Stan Cohen for The Bridgton News) —  A program that has helped seniors understand the many intricacies of Medicare as well as save them millions of dollars, would be eliminated by a budget bill approved in June by the powerful Senate Appropriations Committee. The program is called the State Health Insurance Assistance Program, or SHIP.

Sen. Roy Blunt, R-Mo., chairman of the appropriation committee’s health and labor subcommittee, said in a statement last week: “Cutting these ‘unnecessary federal programs’ helped provide needed funding for other efforts”. How he can call the SHIP program unnecessary is beyond my comprehension. SHIP counselors are in every state, the District of Columbia and the U.S. territories offering free advice on how to choose from an array of drug and health insurance plans, challenge coverage denials, and receive financial subsidies for premiums, co-payments and deductibles. They provide one-on-one counseling as well as host enrollment clinics, informational meetings, special “Welcome to Medicare” events for new beneficiaries and answer questions over toll-free telephone help lines. Local SHIP programs cannot survive without federal support.

Howard Bedlin, vice president at the National Council on Aging said: “Last year SHIPs helped 7 million people navigate this program and without those services, people will not be able to make well-informed choices. That’s going to cost them money.”

I am a SHIP counselor and have been privileged to have helped hundreds of Maine seniors figure out the intricacies of Medicare. Ask them if the SHIP program is worthwhile.

Medicare Volunteer Counselors are available for one-on-one consultations at no charge.  

Medicare services for elderly, low-income, and adults with disabilities

Medicare Savings Program poster

If you are low-income or a working person with a disability, you could benefit from a Medicare Savings Program.

Monthly allowed income limits are higher in Maine than the national guidelines. Call SeniorsPlus to see if you are eligible for assistance -- 207-795-4010 or 1-800-427-1241. 

June Monthly Medicare Message

Gaps in Medicare coverage: Did you know there are many services Medicare Part A and B do not cover?

This means you may have out-of-pocket expenses for deductibles, premiums, co-payments, and more! These gaps in coverage can be filled in with supplemental coverage such as retiree or employer insurance, a Medigap policy, Veterans benefits, Tricare for Life, or a Medicare Savings Program.

To learn more about how to fill in these gaps in coverage, call us at 1-800-427-1241.  

A Medicare NuggetMay 19, 2016

(from Stan Cohen for The Bridgton News) — I’d like to think that our government is ready and willing to make sure that we, the people, are not victims of greed by large corporations. Yet some private Medicare Advantage plan insurers, who cover medical treatment for the elderly, have overbilled the government by billions of dollars and they get away with it! According to a congressional audit released early in May, these plans “have rarely been forced to repay the money or face other consequences for their actions.” The audit was conducted by the Government Accountability Office (GAO) and reported by the Center for Public Integrity, a nonpartisan, nonprofit.

How do they do it? The Medicare Advantage plans use a scheme known as “upcoding.” The higher the risk score they assign to a patient, the more they get in reimbursement from the Center for Medicare and Medicaid Services. In other words, they make more profit when they claim a patient was sicker than the patient actually was.

The GAO called for "fundamental improvements" to curb overbilling by the health plans, which are paid more than $160 billion annually. “While Medicare officials have quietly conducted audits since 2008, they have never imposed stiff financial penalties, even as evidence built-up that billing errors were deeply rooted and wasting tax dollars at an alarming clip.” 

May Monthly Medicare Message

Do you have limited finances?

Do you have, or are you eligible for Medicare?

If you answered “Yes” to either question you may qualify for a Medicare Savings Program (MSP), also known as the Medicare Buy-In program. MSP helps pay your Medicare costs and most of your Medicare prescription drug plan costs.

For more information and help applying for the Medicare Savings Programs call SeniorsPlus at 800-427-1241. 

A Medicare NuggetApril 29, 2016

(from Stan Cohen for The Bridgton News) — An Explanation of Benefits (EOB) is a notice that your Medicare Advantage Plan (or Part D plan) sends you after you receive health care services.

As the Medicare Rights Center points out, the EOB is important because, among other things, if your Medicare Advantage insurer has denied coverage for a service you received, the EOB allows you to begin an appeal. An appeal is when you ask your plan to reconsider its decision to deny coverage. First look for footnotes on the EOB that explain why the service was denied. This will be useful in writing your appeal.

There should be instructions about how to appeal included on the last page of your EOB, and you will need to start your appeal within 60 days of the date of the notice. If possible, it is a good idea to ask your provider (usually your doctor) to help with the appeal by including relevant medical records and a letter of support.

Medicare Volunteer Counselors are available for one-on-one consultations at no charge. 

April Monthly Medicare Message

Medicare prescription drug coverage (Part D) is available to everyone with Medicare. Private companies provide this coverage. You choose the Medicare drug plan and pay a monthly premium. Each plan can vary in cost and specific drugs covered. If you decide not to join a Medicare drug plan when you’re first eligible, and you don’t have other creditable prescription drug coverage, or you don’t get Extra Help, you will likely pay a late enrollment penalty. 

A Medicare Nugget, April 1, 2016

(from Stan Cohen for The Bridgton News) — It is true that Medicare does not generally pay for eye care or eyeglasses, but it will cover cataract surgery under Part B. That means you will be responsible for a co-pay if you do not have a Medicare supplement plan. If you have a Medicare Advantage Plan, contact them before hand to learn about how the plan covers cataract surgery.

Here is what is specifically covered: The removal of the cataracts; basic lens implants; and one set of prescription eyeglasses or contact lenses after the surgery. The glasses would be a basic style – no bells and whistles. You may have a problem having Medicare pay for part of the cost of the specs if you get them from a supplier that does not accept “assignment” from Medicare. About the lens implants: If your provider recommends more advanced implants, you may have to pay some or all of the cost.

March Monthly Medicare MessageMedicare Word Search Puzzle

Senior Medicare Patrol (SMP) is a government program created in 1995 to help Medicare beneficiaries fight fraud, errors, and abuse of the Medicare and Medicaid programs.

See if you can find the words that appear in bold and underlined in the message below the puzzle (click here for larger image).

If you have questions, or think you have been a victim of Identity Theft or Medicare Fraud, contact SeniorsPlus at 1-800-427-1241.

A Medicare Nugget, February 22, 2016

(from Stan Cohen for The Bridgton News) — Two more important Medicare changes are coming in 2016: Starting in April, hospitals in 67 metro areas and communities will be responsible for managing the total cost of Medicare-covered hip and knee replacements. The experiment covers a 90-day window from the initial doctor’s visit, through surgery and rehabilitation. At stake for the hospitals are potential financial rewards and penalties. Medicare’s goal is to improve quality while lowering cost. But hospitals worry about financial consequences and advocates for patients say there’s a potential to skimp on care. This new initiative will need watching.

And about HOSPICE: Patients choosing hospice care at the end of their lives have traditionally had to give up most curative treatment because Medicare does not cover that cost (other than palliative care) while in hospice. Under Medicare’s new Care Choices model, patients with a terminal illness will be able to receive hospice services without giving up treatment. A cancer patient could continue to get chemo, for example. Seventy hospices started the experiment on January 1st, and another 70 will join in two years.

A Medicare Nugget, January 30, 2016

(from Stan Cohen for The Bridgton News) — Medicare Part B covers certain diagnostic eye tests, and treatment of conditions of the eye. Although Medicare will not generally pay for routine eye care, it will cover once-a-year glaucoma screenings for those at risk, including individuals with diabetes or a family history of glaucoma.

Generally, people who get periodic eye exams (which are highly recommended for seniors like us) are automatically screened for Glaucoma which is a group of diseases that can cause optic nerve damage, sight impairment, and eventual vision loss. Glaucoma cannot be cured, but symptoms can be lessened or prevented with early detection and treatment. Those with Medicare Advantage plans should check with the plan about coverage for eye exams.

Medicare Volunteer Counselors are available for free, one-on-one consultations. Call SeniorsPlus at 1-800-427-1241 to arrange for an appointment. 

A Medicare Nugget, January 14, 2016

(from Stan Cohen for the Bridgton News) — If your doctor wants to change your prescription or prescribe an additional drug, make sure that your Medicare drug plan covers the medicine. Show your doctor a copy of your Part D plan’s drug list (formulary). You should have received a copy of the formulary when you received your plan ID card. If you do not have the plan’s formulary, call the plan (their phone number is on the back of the ID card) and ask them if the newly prescribed drug is covered. Alternatively, your physician can go “on-line” to the plan’s web site to find out.

If your doctor wants to prescribe a drug for you that is not covered by your Part D plan, you can request a “coverage determination”. You, your doctor, or your appointed representative can call your plan or write them a letter to request that they cover the prescription you need. If the plan denies your request you can appeal. The best place to get help with your appeal is Maine Legal Services for the Elderly. They have a special hot line for this very purpose [1-877-774-7772] and can provide your doctor with the necessary information. Once your plan has received your request, it has 72 hours to notify you of its decision. Take note: Medicare beneficiaries often win their Part D appeals.

Medicare counselors are available for free, one-on-one consultations. Call SeniorsPlus at 207-795-4010 to schedule your appointment.