Published by: AARP

Medicare covers the majority of older Americans’ health care needs, from hospital care and doctor visits to lab tests and prescription drugs. Here are some needs that aren’t part of the program.

1. Opticians and eye exams

While original Medicare covers ophthalmologic expenses such as cataract surgery, it doesn’t cover routine eye exams, glasses or contact lenses. Nor do any Medigap plans, the supplemental insurance that is available from private insurers to augment Medicare coverage. Some Medicare Advantage plans cover routine vision care and glasses. ​​

2. Hearing aids

Medicare covers ear-related medical conditions, but original Medicare and Medigap plans don’t pay for routine hearing tests or hearing aids. ​

3. Dental work

Original Medicare and Medigap policies do not cover dental care such as routine checkups or big-ticket items, including dentures and root canals.

4. Overseas care

Original Medicare and most Medicare Advantage plans offer virtually no coverage for medical costs incurred outside the U.S. ​​

5. Podiatry

Routine medical care for feet, such as callus removal, is not covered. Medicare Part B does cover foot exams or treatment if it is related to nerve damage because of diabetes, or care for foot injuries or ailments, such as hammertoe, bunion deformities and heel spurs.

6. Cosmetic surgery

Medicare doesn’t generally cover elective cosmetic surgery, such as face-lifts or tummy tucks. It will cover plastic surgery in the event of an accidental injury or if needed after another treatment, such as breast reconstruction following a mastectomy.

7. Chiropractic care

Original Medicare does not cover most chiropractic services or the tests that a chiropractor orders, including X-rays. Medicare Part B does pay for one chiropractic service: manual manipulation of the spine by a chiropractor or other qualified provider to correct a vertebral subluxation, which is basically a partial dislocation of a spinal vertebra from its normal position.

8. Massage therapy

​Original Medicare doesn’t cover massage therapy, often used to help reduce chronic pain, although research suggests it may provide short-term, but not long-term, relief. When it comes to pain management, Medicare covers chiropractic care in certain limited circumstances and physical and occupational therapy when prescribed by a doctor. Some Medicare Advantage plans might cover some massage therapy. It’s best to call your plan to find out if it does. ​​

9. Nursing home care

​Medicare pays for limited stays in rehab facilities — for example if you have a hip replacement and need inpatient physical therapy for several weeks. But if you become so frail or sick that you must move to an assisted living facility or nursing home, Medicare won’t cover your custodial costs. (Nursing homes average about $90,000 yearly for a semi-private room and more than $100,000 for a private room. Costs vary based on where you live and what facility you choose.) ​​

10. Concierge care

Some physicians and their practices require a membership fee in order for them to treat you. They advertise that this makes them more responsive and available to their patients. The fees, which can run thousands of dollars a year, vary depending on the concierge or boutique practice. Medicare will not cover these fees. Note that once you’ve paid that fee, if your doctor participates in Medicare he or she must offer all the services Medicare does with the same copays and coinsurance rules applying.

The post 10 Things Medicare Doesn’t Cover appeared first on C-Medisolutions.

You may be exposed to Medicare fraud at any time before you enroll in a plan when you access care at a doctor’s office or a facility, or at other times. Learn about common behaviors and actions below that may help you recognize and protect yourself from fraudulent activity.

Billing fraud

If you have Original Medicare, your doctor should not:

• Charge you for most preventive services
• Offer tests or other services that you do not need, especially if the doctor says that the more tests you receive, the cheaper they are
• Routinely waive your coinsurance (providers can waive cost-sharing for patients with great financial need, but not regularly)

Always confirm that you received the services listed on either your Medicare Summary Notice (MSN) or your Explanation of Benefits (EOB). Sometimes this can be hard to do if you receive services from several doctors at the same time. If you returned durable medical equipment (DME), your supplier should not continue to charge Medicare for rental fees or maintenance.

To report fraud, you should contact 1-800-MEDICARE (633-4227), the Senior Medicare Patrol (SMP) Resource Center (877-808-2468), or the Inspector General’s fraud hotline at 1-800-HHS-TIPS (447-8477). Medicare will not use your name while investigating if you do not want it to.

Marketing fraud

You are being misled if an agent from an insurance company says that you:

• Must sign up for a Medicare Advantage Plan to get Medicare drug coverage (you can also keep Original Medicare and enroll in a stand-alone Part D plan)
• Will pay a higher Part B premium unless you sign up for a certain plan (some plans help pay your Part B premiums or charge additional premiums, but your Part B premium will not increase based on your coverage choices)
• Must invite a plan representative to your home to get information about the plan or to enroll
• Can switch back to Original Medicare at any time if you are dissatisfied with the plan, without providing information about enrollment periods
• Will receive additional benefits that are actually Medicare-covered services
• Will receive additional benefits, such as dental or vision, that are actually covered by other insurance you have or are eligible for (such as Medicaid)
• Will lose your Medicaid benefits unless you sign up for a certain plan

Make sure to verify any marketing information you receive in the plan’s benefit manual or by calling the plan directly. Avoid enrolling in error by confirming whether the plan:

• Provides drug coverage
• Offers coverage through the coverage gap
• Has your providers, hospitals, and pharmacies in their network
• Offers additional benefits, such as vision or dental

Note: Insurance agents and brokers may receive a large fee for getting you to sign up for a Medicare private plan.

Never feel pressured to join any plan. Always make sure you understand what the plan is offering you, and how all your benefits are affected. Ask to receive information about the plan’s benefits in writing. If you suspect that an agent is not following the rules, save documented proof (such as the agent’s business card or marketing materials). Contact your State Insurance Department or State Attorney General Consumer Helpline to report your concerns.

If you find out that your plan has made fraudulent claims about your health or drug coverage, you may be eligible for a Special Enrollment Period (SEP) to disenroll from your plan and switch to another one.

The post Recognizing Medicare Fraud appeared first on C-Medisolutions.

Published by: Medicare

The Public Health Emergency for COVID-19 ended on May 11, 2023. After May 11, 2023:

• Medicare will continue to cover vaccines without cost sharing.
• You might have cost-sharing for COVID-19 diagnostic tests.
• Medicare won’t cover over-the-counter (OTC) tests.
• Telehealth services will continue through December 31, 2024.

Keep reading to learn more about these changes.

Get a COVID-19 vaccine as soon as you can.

Medicare covers the updated COVID-19 vaccine at no cost to you. The updated vaccine targets the original COVID-19 viral strain and 2 Omicron variants (BA.4/BA.5). Medicare covers the vaccine for anyone who has Medicare. Be sure to bring your Medicare card.

• The updated Pfizer vaccine is available for people 5 and older.
• The updated Moderna vaccine is available for people 6 and older.

Note: Some adults 18 years and older who have completed their primary vaccine series have the option to get a Novavax vaccine instead of the updated Pfizer-BioNTech or Moderna COVID-19 vaccine. Visit CDC.gov to learn more about the Novavax vaccine.

If you:

• Already had at least 1 shot of the original COVID-19 vaccine but haven’t gotten the updated vaccine: You can get the updated vaccine at least 2 months later.
• Are 65 or older and got the updated vaccine at least 4 months ago: You can get a second shot of the updated vaccine.
• Are immunocompromised (like people who have had an organ transplant and are at risk for infections and other diseases) and got 1 shot of the updated vaccine at least 2 months ago: You can get a second shot. Your healthcare provider can determine if and when you should get additional shots of the updated vaccine.

COVID-19 vaccines are safe and effective. Get details about the vaccine.

If you have Medicare and have a disability or face other challenges in getting to a location away from home for a vaccination, Medicare will pay a doctor or other care provider to give you the COVID-19 vaccine in your home. You might need to give them your Medicare Number for billing, but there’s still no cost to you for the vaccine and its administration.

The post Medicare & Coronavirus appeared first on C-Medisolutions.

Published by: medicareresources.org

What is Medicare Part B?

Medicare Part B picks up – to a large extent – where Medicare Part A leaves off.  Part B coverage pays for a broad range of medically necessary services that aren’t picked up by inpatient coverage – even though they might be received while a person is hospitalized – including ambulance services, certain surgical procedures, dialysis, mental health care, physical therapy, transplants, chemotherapy and radiation, urgently needed care and more.

In addition, Part B covers diagnostic tests (such as MRIs, CT scans, EKGs, and x-rays) and a host of preventive medical services, such as pap tests, HIV screening, glaucoma tests, hearing tests, diabetes screening, and colorectal cancer screenings. Part B also pays the costs of durable medical equipment such as wheelchairs, hospital beds, and oxygen equipment, and for drugs that are taken by infusion (most drugs are covered under Medicare Part D, but drugs administered via infusion are covered under Part B instead).

Is there a premium for Part B?

Yes. The premium tends to increase from year to year, but for 2023, it’s declining for the first time in more than a decade. For most enrollees, the 2023 Part B premium will be $164.90/month.

The reduction in Part B premiums for 2023 stems from lower-than-anticipated Part B spending in 2022, leaving the government with a surplus that could be used to reduce Part B premiums for 2023. This was partly due to lower-than-expected spending on Aduhelm, the new Alzheimer’s drug that’s given by infusion in a doctor’s office.

Medicare Part B premiums can be covered by Medicaid if the beneficiary is eligible for both programs. And high-income enrollees pay more than the standard premiums for Part B.

How do I enroll in Part B?

If you are already receiving Social Security or Railroad Retirement benefits, you will be notified three months prior to your 65th birthday that you are about to become a Part A Medicare enrollee, and that Part B is an option. You’ll receive the Part B card at the same time as the Part A card.

If you choose not to enroll in Part B, you must return the card (which means you’re rejecting Part B coverage; more on that below) or the premium will automatically start to be deducted from your Social Security checks. If you keep the card, Part B coverage kicks in the month you turn 65.

If you’re not already receiving Social Security or Railroad Retirement benefits, you’ll have an opportunity to enroll in Medicare B (along with Medicare A) during a seven-month window that includes the three months before the month you turn 65, the month you turn 65, and the following three months.  If you enroll in the three months prior to the month you turn 65, your coverage will be effective the month you turn 65.

It’s important to note that if you fail to enroll in Part B during your seven-month enrollment period, the program will offer you another opportunity to enroll each succeeding year (January 1 – March 31), with coverage effective the month after you enroll (note that the effective date used to be July 1, but this changed as of 2023, under the BENES Act). The catch? If and when you do eventually enroll in Medicare B, for each year that you were eligible for Part B but turned it down, your monthly premium will be increased by 10%, and the higher rate will be in place for as long as you have Part B.

So if you wait three full years to enroll after your initial enrollment period, you’ll pay premiums that are 30% higher than the normal price, for as long as you have Part B coverage (generally, for life). The penalty does not apply, however, if you delay your Part B enrollment because you have other coverage in place from a current employer or your spouse’s current employer.

The post Medicare Part B – enrollee benefits and coverage costs appeared first on C-Medisolutions.

Hospice is a program of end-of-life pain management and comfort care for those with a terminal illness. Medicare’s hospice benefit is primarily home-based and covers end-of-life palliative treatment, including support for one’s physical, emotional, and other needs. It is important to remember that the goal of hospice is to help an individual be as comfortable as possible, not to cure an illness.

To elect hospice, someone must:

• Be enrolled in Medicare Part A
• Have a hospice doctor certify that they have a terminal illness, meaning a life expectancy of six months or less if the illness takes its normal course
• Sign a statement electing to have Medicare pay for palliative care (pain management), rather than curative care
• And, receive care from a Medicare-certified hospice agency

Once an individual chooses hospice, all of their hospice-related services are covered under Original Medicare, even if they are enrolled in a Medicare Advantage Plan, unless their Medicare Advantage plan is part of a specific demonstration program, in which case the plan will pay for hospice care. Their Medicare Advantage Plan will continue to pay for any care that is unrelated to their terminal condition. Original Medicare payments to the hospice provider also cover any prescription drugs needed for pain and symptom management related to the terminal condition. The individual’s stand-alone Part D plan or Medicare Advantage drug coverage may cover medications that are unrelated to their terminal condition.

The hospice benefit includes two 90-day hospice benefit periods followed by an unlimited number of 60-day benefit periods The doctor must recertify the person’s terminal illness before each benefit period.

If someone you care for is interested in Medicare’s hospice benefit:

• Ask their doctor whether they meet the eligibility criteria for Medicare-covered hospice care.
• Ask their doctor to contact a Medicare-certified hospice on their behalf.
• Be persistent. There may be several Medicare-certified hospice agencies in your area. If the first one you or the doctor contact is unable to help, contact another.

Once you have found a Medicare-certified hospice:

The hospice medical director (and the individual’s regular doctor if they have one) will certify that they are eligible for hospice care. Afterward, the individual must sign a statement electing hospice care and waiving curative treatments for their terminal illness.

Their hospice team must consult with the individual (and their primary care provider, if they wish) to develop a care plan. Their team may include a hospice doctor, a registered nurse, a social worker, and a counselor.

The post How does Medicare cover hospice care? appeared first on C-Medisolutions.

Once you turn 65 and enroll in Medicare, you might expect that a significant portion of your retirement planning has been completed. Now you have a plan to cover all of your medical needs for the rest of your life, right? Well… Not exactly.

While Medicare does provide relatively comprehensive healthcare coverage for routine screenings, in-office visits, hospitalization, and more, the system doesn’t exactly provide for every medical need. Depending upon the situation, you might still pay out of pocket for a number of services, such as dental and vision care.

Original Medicare does not offer coverage for dental and vision, except in certain emergency situations. Those who enroll in Original Medicare will have to pay for these services on their own.

On the other hand, some Medicare Advantage plans do include coverage for dental and vision care. These healthcare plans are put together by private health insurance companies that contract through Medicare, and each plan is structured a bit differently. So, in order to identify a Medicare Advantage plan that provides the services that matter to you, it is best to conduct some comparison shopping with the help of a professional.

If your Medicare Advantage plan does offer vision care, it will usually cover preventive screenings, vision exams, and corrective lenses. Dental care can vary, but might include some or all of the following benefits:

• Routine dental exams
• X-rays
• Routine cleanings
• Fillings
• Extractions
• Root canals
• Gum disease treatment
• Dentures
• Dental implants
• Bridges
• Crowns

A Medicare Advantage plan might appeal to you because you can receive most of your healthcare services through one plan while paying one premium. For many retirees, this is the easiest way to manage their healthcare expenses. But we definitely recommend that you carefully compare your options under the guidance of one of our insurance professionals, so that we can help you identify an Advantage plan that suits your needs.

The post Does Medicare Cover Dental and Vision Care? appeared first on C-Medisolutions.

Published by Ritter Insurance Marketing 

The Centers for Medicare & Medicaid Services have announced the 2022 premiums, deductibles, and coinsurance amounts for the Medicare Part A and Part B programs. This year’s Part B premium increase is the largest monetary cost jump in history, though not percentage-wise. We detail the cost changes for Original Medicare below!

Part B – Highest-Ever Increase by Dollar Amount

On Friday, November 12, CMS announced that the monthly Medicare Part B premium will be $170.10 for 2022, an increase of $21.60 from $148.50 in 2021. The annual deductible for Medicare Part B beneficiaries increased $30, from $203 in 2021 to $233 in 2022. This 14.5 percent increase is the third largest since 2007.

Whether the Part B monthly premium increases or decreases is affected by the annual Cost of Living Adjustment (COLA), which is rising this year to a historic 39-year high. A rise in COLA typically means there will be a rise in Part B premiums. A beneficiary’s annual income directly impacts their monthly Part B premium.

However, CMS ensures that this year’s COLA increase “will more than cover” the simultaneous rise in premium and deductible prices.

Here’s how your clients’ annual incomes will affect their Medicare Part B monthly premiums for 2022:

Part A

Medicare Part A is premium-free for more than 99 percent of beneficiaries. Less than one percent of Medicare beneficiaries must pay the Part A premium because they do not have at least 40 quarters of Medicare-covered employment. Those who have paid Medicare taxes for less than 30 quarters will pay a Part A premium of $499 per month in 2022, up from $471 per month in 2021 — a $28 increase. Beneficiaries who have paid Medicare taxes for 30 to 39 quarters will pay a Part A premium of $274 per month in 2022, up from $259 per month in 2021.

The Medicare Part A inpatient hospital deductible that beneficiaries will pay when admitted to the hospital for 2022 will be $1,556, which is an increase of $72 from $1,484 in 2021. Part A coinsurance amounts will increase in 2021 as shown in the table below.

2022 Part A Deductible & Coinsurance Amounts

The best insurance agents are the most knowledgeable about information like this that directly impacts the abilities of their clients to afford quality Medicare coverage. By staying up to date, you can serve as a well-informed, reliable, and trusted guide for your clients throughout the insurance sales process. Editor’s Note: Table information is from The Centers for Medicare & Medicaid Services.

The post 2022 Medicare Part A and Part B appeared first on C-Medisolutions.

WHAT TO THINK ABOUT at RENEWAL TIME

What to consider when holiday shopping includes searching for new health coverage

Open enrollment happens every year from October 15 to December 7. And while you may be pleased with your Medicare coverage. It’s still important to take time to review your benefits and consider whether you want to change plans for the coming year. While you may not like the idea of having to compare plans annually (shouldn’t once be enough?), doing so could save money–and more than a few headaches.

As renewal time draws near, focus on the three C’s: coverage, costs, and care. That is, make sure your healthcare needs (including drugs) are covered, at a price you can afford, from providers you trust. Simple, right?

What’s Not Changing

The benefits you receive from Original Medicare won’t generally change from year to year because they’re determined by the government.  Likewise, if you have a Medigap policy, your benefits won’t change, either. Medigap plans themselves are also standardized by the government, even though they’re provided by private insurers. Your premiums for Original Medicare and Medigap won’t go up beyond the rate of inflation unless:

• Your income Goes Up

A higher-income could affect whether you pay an income-related monthly adjustment amount for Part B.

• Your Medigap Policy Premium Is Based on Attained-Age

If so, your premium will go up each year on your birthday—but if you did your homework, this increase shouldn’t come as a surprise.

Original Medicare and Medigap policies can be used anywhere in the country. This means that you’ll still be covered if you move or you’re a winter traveler, no matter where you are. There’s no need to renew your Original Medicare and Medigap plan each year. Your coverage will continue unchanged as long as you pay your premiums.

What Can Change

Part D plans and Medicare Advantage plans make changes reasonably frequently. Any changes for the coming year must be detailed in your plan’s Annual Notice of Change (ANOC), which you’ll receive by the end of September. If you haven’t received it by the beginning of October, call your plan and request one immediately, so you’ll have plenty of time to review it.

There may be changes to:

• Your Part D formulary
• Your Part D pharmacy network
• Your MA plan’s provider network
• Your MA plan’s policies
• Your premiums of deductibles for MA or Part D

Your plan willingness to grant you an exception for specific drug coverage can also change.

CHANGING YOUR COVERAGE

Just because your plan made an exception to cover a drug outside of its formulary this year doesn’t mean it has to do so next year. Call your plan to ask whether or not you’ll need to reapply for the exception. Suppose plan administrators are going to make it difficult to get the drugs you need. In that case, you may be better off switching plans while you have the opportunity.

Back to the Plan Finder

Using Medicare’s Plan Finder (medicare.gov/find-a-plan)—the online tool provided by the government that helps you find a private insurer—can seem tedious at first. However, you’ll likely find that the process gets easier as you get used to it. Even if it doesn’t, using it is still worth the time and effort cause even if your plan’s ANOC doesn’t detail any changes that could affect you. Other plans may have made changes that could make them a better option. For example, a new insurance company could have entered your area, offering a comparable plan to yours but with a much lower premium or deductible. If you don’t bother to check the Plan Finder, you may never hear about new, more attractive options.

Switching from Medigap to Medicare Advantage

Suppose until now you’ve had Original Medicare with a Medigap plan. In that case, you may be considering switching to a Medicare Advantage plan for additional benefits or to limit your out-of-pocket expenses. Be careful if you decide to take this step because you may not be able to get it back once you leave Medigap.

Here is what happens when you drop a Medigap policy:

• Your first 12 months in your new MA plan are considered a “trial period.” You can still switch back to your original Medigap plan with the same benefits and the same government protections that you had previously during this trial period.
• This special protection only applies the first time that you switch from Medigap to Medicare Advantage. And it only applies if you already had a Medigap policy. You can’t take advantage of the trial period if you’re simply going from Original Medicare (with no Medigap) to MA.
• After a 12-month trial period, you no longer have the guaranteed right to a Medigap plan and maybe denied one in the future. However, you’ll still be able to switch between MA plans.

The post RENEWAL TIME appeared first on C-Medisolutions.