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: AARP

If you’re just finding out that original Medicare doesn’t cover routine dental care or procedures, you’re not alone. Many people don’t realize this until they retire.

Medicare limits dental coverage to specific medically related circumstances, so yearly exams, extractions, root canals, and routine cleanings aren’t part of the plan. Medical-related coverage may include surgery to treat jaw fractures, limited dental services in preparation for radiation treatment of oral cancer, or an oral exam in a hospital before a kidney transplant.

1. Medicare Advantage coverage varies

Almost all Medicare Advantage plans provide some dental coverage. Only 10 percent of Medicare Advantage enrollees are required to pay a separate premium for dental benefits, according to KFF.

“Most plans cover preventive services, such as cleanings and X-rays, but the coverage of more extensive services definitely varies,” Freed says. The KFF study found nearly two-thirds of enrollees in plans with access to cleanings, oral exams, and X-rays don’t have to pay for these services.

2. Stand-alone dental policies aren’t all alike

Even though Medicare Advantage is the most common way for Medicare beneficiaries to get dental coverage after retirement, you have other options.

Premiums for stand-alone dental policies vary based on coverage level and location. Policies generally don’t have preexisting condition exclusions but may require a waiting period before covering some expensive procedures, says Gregg Ratkovic, chief business officer for insurance broker eHealth. They can also have an annual coverage cap.

3. Other options for dental coverage

You may be eligible for dental coverage from other sources:

Dental discount programs. These programs typically charge an up-front annual fee and provide discounts such as 30 percent to 40 percent off cleanings, crowns, exams, and fillings. You may be required to use certain dentists.

Employer or retiree dental coverage. Half the people 65 or older who had dental insurance had coverage through an employer or retiree plan, according to the National Poll on Healthy Aging.

Medicaid. The joint federal-state program provides dental coverage in some states for people who meet income and asset requirements. About 1 in 9 Medicare beneficiaries had dental coverage through Medicaid in 2019, according to the KFF study. Fewer than half the states provide care beyond emergency dental services for adults. Contact your state Medicaid office for details.

Medigap add-ons. Medigap policies, which help cover original Medicare’s out-of-pocket costs, don’t include dental coverage in their standardized benefits, but some plans let you add on dental coverage for an additional premium. In 2020, about 1 in 8 Medicare beneficiaries were enrolled in Medigap plans with additional dental, hearing or vision benefits, according to the Commonwealth Fund.

Veterans benefits. The U.S. Department of Veterans Affairs provides dental care benefits to veterans who qualify based on their service-connected disability rating and other factors.

4. Your dentist can help you plan

Before you retire, talk with your dentist about the care that’s important to have in the next few years, says Leonard Brennan, a retired dentist, and co-director of the Harvard School of Dental Medicine’s Geriatric Fellowship Program. If you need some expensive services, consider scheduling them while you still have dental coverage from your employer. It could be better than your future coverage.

5. Tax-free HSA money can help with dental costs

If you had a high-deductible health insurance policy and made contributions to a health savings account (HSA), you can withdraw money tax-free for eligible medical expenses, including out-of-pocket dental costs.

You can’t make new contributions to an HSA after you enroll in Medicare, but you can withdraw money tax-free for eligible expenses at any age. If you haven’t enrolled in Medicare yet, setting aside money in an HSA is a good way to prepare for these costs.

The post 5 Things You Should Know About Dental Coverage and Medicare appeared first on C-Medisolutions.

Your health is important and needs to be protected. If you are 65 or older or have certain disabilities, or End-Stage Renal Disease, you can get health care coverage through the Medicare program. You’ll get access to health care services you need to achieve and maintain good health.

It’s important to review your Medicare coverage options and find an affordable option that meets your healthcare needs.

Medicare coverage options

There are two types of Medicare coverage:

• Traditional or Original Medicare.
• Medicare Advantage.

Original Medicare helps cover inpatient care in hospitals, skilled nursing facility care, hospice care, and home health care. It also covers:

• Services from doctors and other health care providers.
• Outpatient care.
• Durable medical equipment (like wheelchairs, walkers, hospital beds, and other equipment).
• Preventive services (like screenings, certain vaccines, and annual wellness visits).

Original Medicare is often referred to as Part A and Part B. You can go to any doctor or hospital, anywhere in the United States, that accepts Medicare. If you have Original Medicare, you can also buy a Medicare Supplement Insurance (Medigap) policy from a private insurance company. Original Medicare pays for much, but not all, of the cost for covered health care services and supplies. A Medigap policy can help pay some of the remaining health care costs, such as copayments, coinsurance, and deductibles.

Medicare Advantage bundles your Original Medicare – and usually Medicare prescription drug coverage – into one health insurance plan. If you select Medicare Advantage coverage, you join a plan offered by Medicare-approved private companies.

Each plan can have different rules for how you get services – like referrals to see a specialist. All plans must cover emergency and urgent care, as well as all medically necessary services covered by Original Medicare.

In many cases, you can only use doctors and other providers who are in your plan’s network and service area. Costs for monthly premiums and services vary depending on which plan you join. Some plans may offer some extra benefits that Original Medicare doesn’t cover — like vision, hearing, and dental services.

Whether you choose Original Medicare or Medicare Advantage, be sure you have prescription drug coverage. You can join a Medicare Prescription Drug Plan (called a PDP) in addition to Original Medicare. You can also get it by joining a Medicare Advantage plan with Medicare prescription drug coverage.

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Many people with osteoporosis don’t know they have it until they break a bone. If you think you may be at risk, talk with your doctor about getting a bone mass measurement. This test can help prevent or detect osteoporosis at an early stage when treatment works best.

Medicare Part B covers a bone mass measurement once every 24 months (more often if medically necessary) — at no cost to you when your doctor orders it.

Along with getting tested, here are more ways to keep your bones strong:

• Eat foods that support bone health, like leafy green vegetables and fish
• Exercise by doing weight-bearing activities, like strength training or hiking
• Don’t smoke, and limit your alcohol consumption

Remember: Your risk of osteoporosis grows as you get older. 1 in 5 women and 1 in 20 men over the age of 50 will develop osteoporosis, so it’s important to take steps early to help protect your bones!

Bone mass measurements

Medicare Part B (Medical Insurance) covers this test once every 24 months (or more often if medically necessary) if you meet one or more of these conditions:

• You’re a woman whose doctor determines you’re estrogen-deficient and at risk for osteoporosis, based on your medical history and other findings.
• Your X-rays show possible osteoporosis, osteopenia, or vertebral fractures.
• You’re taking prednisone or steroid-type drugs or are planning to begin this treatment.
• You’ve been diagnosed with primary hyperparathyroidism.
• You’re being monitored to see if your osteoporosis drug therapy is working.

Your costs in Original Medicare

You pay nothing for this test if the doctor or other health care provider accepts the assignment.

Note

Your doctor or other health care provider may recommend you get services more often than Medicare covers. Or, they may recommend services that Medicare doesn’t cover. If this happens, you may have to pay some or all of the costs. Ask questions so you understand why your doctor is recommending certain services and if, or how much, Medicare will pay for them.

The post Love your bones appeared first on C-Medisolutions.

Preventive care is the care you receive to prevent illness, detect medical conditions, and keep you healthy. Medicare Part B covers many preventive services, such as screenings, vaccines, and counseling. If you meet the eligibility requirements and guidelines for a preventive service, you must be allowed to receive the service. This is true for Original Medicare and Medicare Advantage Plans. However, your plan’s coverage rules may apply.

Original Medicare: You pay nothing (no deductible or coinsurance) for most preventive services when you see a participating provider.

Preventive services recommended by the U.S. Preventive Services Task Force are covered at 100% of the Medicare-approved amount (zero cost-sharing), but for other services, you may be charged Original Medicare cost-sharing.

• You may be charged if you see a non-participating or opt-out provider.
• Medicare Advantage: When seeing an in-network provider, you pay nothing for preventive services that are covered with zero cost-sharing by Original Medicare. This means that plans are required to cover your care without charging deductibles, copayments, or coinsurance, as long as you meet Medicare’s eligibility requirements for the service.
• Medicare Advantage Plans may charge you for preventive services that Original Medicare does not cover with zero cost-sharing.
• You may be charged if you see an out-of-network provider.

Under certain circumstances, you may be charged for services you receive related to your preventive service, even if the preventive service itself is covered at 100% of the cost. For example:

• During the course of your preventive care, your provider may discover and need to investigate or treat a new or existing problem. This additional care is considered diagnostic, meaning your provider is treating you because of certain symptoms or risk factors. Medicare may bill you for any diagnostic care you receive during a preventive visit. For example, if your doctor finds and removes a polyp during a colonoscopy, costs related to removing the polyp will apply.
• You may have to pay a facility fee depending on where you receive your preventive care. For example, certain hospitals charge separate facility fees when you receive a preventive service.
• You may be charged for a doctor’s visit if you meet with a doctor before or after receiving your preventive care.

Keep in mind that each preventive service has its own eligibility requirements and guidelines. Medicare may only cover a service a certain amount of times each year or under specific circumstances.

Note: Medicare may cover certain preventive services more frequently than guidelines suggest if they are needed to diagnose or treat an illness or condition.

The post Medicare Preventive services overview appeared first on C-Medisolutions.

Once you know what you want from a primary care provider (PCP) or specialist, you may want a list of providers in your area from which to choose. You may ask for referrals from friends, relatives, coworkers, and/or neighbors. You can also check with your insurance plan, medical societies, hospitals, and accreditation organizations. Be aware that while these sources can provide a list of doctors, they will not necessarily provide quality information.

Note: If you have Original Medicare, make sure to see participating providers wherever possible. If you have a Medicare Advantage Plan, make sure to follow your plan’s network rules.

The following sources can help you find lists of healthcare providers and learn more about their quality.

Medicare: To find a provider who accepts Original Medicare, call 1-800-MEDICARE (633-4227) or use Medicare’s Physician Compare tool. If you have a Medicare Advantage Plan, contact your plan for a list of in-network providers.

American Medical Association (AMA): The AMA offers a search engine on its website where you can find doctors in your area by specialty. You can also check on training and board certification.

The American Board of Medical Specialties (ABMS): ABMS is a nonprofit organization consisting of 24 medical specialty boards that oversee physician certification. You can look up a specific doctor’s credentials or find doctors who are board-certified in a specific specialty in your area. The service is free, but you must sign up before you can do a search. ABMS also publishes a book listing doctors: The Official ABMS Directory of Board-Certified Medical Specialists is available at many hospitals, Social Security offices, Area Agencies on Aging, senior centers, and local libraries.

Administrators in Medicine (AIM): If you know the name of a particular doctor, you can look them up on AIM’s website. AIM is a group of state medical board directors. You can see physicians’ licensing backgrounds and whether or not they have had any disciplinary action taken against them.

While these resources cannot ensure that a particular doctor is the best one for you, they do provide information on a doctor’s knowledge and skills. Some tell you which doctors are board-certified, which means they have completed a training program in a specialty and have passed a board exam on the subject. Keep in mind, though, that while board certification is a good measure of a doctor’s knowledge, it does not guarantee a doctor’s quality or that they will be a good fit for you.

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