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Patricia Carrera

Are COVID-19 vaccines covered by Medicare?

Vaccines are getting increasingly more available. Are you wondering how it will be coverage if you have Medicare?  Administration and vaccine cost are covered by Part B of Medicare.

For more information CLICK HERE

Note
Medicare Advantage Plans can’t charge copayments, deductibles, or coinsurance for clinical lab tests to detect or diagnose COVID-19.

Stay up to date & more information on COVID-19 & Medicare. CLICK HERE

Women Worry More Than Men About Senior Healthcare Costs, Data Shows

Medical care is a significant retirement expense. Here’s how to plan for it

It’s no secret that healthcare is a huge expense for seniors. But new data from MedicareGuide.com reveals that women worry more about it than men.

In a recent survey of Medicare enrollees aged 65 and over, 66% of women said they’re concerned about their ability to pay for future healthcare costs. By comparison, only 51% of men said the same.

Furthermore, 18% of women reported having trouble paying for prescription drugs within the last year. On the other hand, only 11% of men claimed a similar hardship.

Read more here

Long Term Care Insurance

Last Updated 10/5/2020

Issue: The long-term care insurance (LTCI) market has evolved significantly since the introduction of LTCI in the 1960s. In the past decade, the market has grown from covering fewer than three million lives to now covering approximately seven million lives. According to the U.S. Department of Health and Human Services (HHS), about 12 million of America’s senior citizens will require long-term care by 2020.

Despite the growing need, the number of insurers offering LTCI coverage has decreased from slightly over 100 in 2004 to about a dozen in 2018. Additionally, premium rates for newly-issued policies have risen as the remaining writers have refined their pricing.

LTCI policies incorporate a number of long-term care (LTC) service alternatives, including home health care, respite care, hospice care, personal care in the home, services provided in assisted living facilities, adult day care centers and other community facilities. Public programs, such as Medicare and Medicaid, also cover certain limited LTC services. As our population ages, the need for LTC support and services will increase and require innovative new approaches. More on this topic and other issues related to the aging population can be found in the presentation videos for the CIPR’s June 16, 2015 symposium, Boom or Bust? A Look into Retirement Issues Facing Baby Boomers.

The decision to purchase LTCI and the premium charged may be influenced by one’s age and life expectancy, gender, family situation, health status, income and assets.

  • Age and Life Expectancy: The younger you are when you purchase an LTCI policy, the lower your premiums will be. The longer one lives, the more likely the need for LTC.
  • Gender: Women are more likely to need LTC, because, on average, they have longer life expectancies than men.
  • Family Situation: If a family member is not available to provide care, paid care, provided inside or outside the home, may be the only alternative.
  • Health Status: A family history of chronic or debilitating health conditions could indicate a greater probability of requiring LTC in the future.
  • Income and Assets: An LTCI policy may be used to protect accumulated assets. Some experts recommend LTCI premiums should not exceed five percent of income.

For more info click here

Click Here For Consumer Buyer’s Guide

Life insurance is for those who stay behind, it is for those to continue to live

Understand What Life Insurance Is – Life insurance pays a death benefit if you die while the policy is in effect, in exchange for premiums you pay before your death. You can use the death benefit to protect against financial hardships such as loss of your income, funeral expenses, medical or nursing care expenses, debt repayments, and child care costs after your death.

Click Here to see the Buyer’s Guide

What Is A Serious Illness?

It is never easy for a patient to receive a diagnosis with a serious illness. Patients and their loved ones must navigate treatments, planning, setbacks, and numerous challenges while dealing with complicated emotions and fears. Recognizing the difficulties of serious illness, health insurance providers have set out to help, support, and ease the journey for patients, caregivers and loved ones. Ensuring access to tools, education, and services for patients and their loved ones during a difficult time can provide the opportunity to plan, allow patients to maintain their dignity and choice, and support loved ones to know their role and how best they can help.  

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Trends of enrollment and demographics of Medicare Supplements plans.

What Is Medicare Supplement? Medicare Supplement (also known as Medigap) is a key source of additional coverage for Medicare enrollees to further protect their health and financial security. Seniors purchase Medigap coverage to protect themselves from high out-of-pocket costs not covered by traditional Medicare, to budget for medical expenses, and to avoid the confusion and inconvenience of handling complex bills from health care providers. 

Click Here For More Information

Federal Issue Coverage Plan for COVID-19 Vaccine & Treatments

WASHINGTON (AP) — Federal health officials Wednesday issued insurance coverage rules designed to deliver on the promise that every American will have access to free COVID-19 vaccines when they are approved.

The regulations from the Centers for Medicare and Medicaid Services, or CMS, will also increase what Medicare pays hospitals for COVID-19 treatments. The changes arrive at a time when coronavirus infections are rising in much of the country, signaling a third wave that could eclipse the number of cases seen earlier this year.

Congress and President Donald Trump have already enacted legislation that calls for vaccines to be free, but the new rules were needed to align that policy with the many arcane payment requirements for public and private insurance

“CMS is acting now to remove bureaucratic barriers while ensuring that states, providers and health plans have the information and direction they need to ensure broad vaccine access and coverage for all Americans,” agency head Seema Verma said in a statement.
The rules aim to resolve potential legal issues over whether Medicare could cover a vaccine that receives “emergency use authorization” from the Food and Drug Administration. That’s a step short of full approval, and questions arose about whether Medicare could pay under its standard coverage policies.

Under Wednesday’s announcement:

— Seniors with traditional Medicare will pay nothing for COVID-19 vaccines, and any copays and deductibles are waived.

— The government will pay private Medicare Advantage plans to administer the vaccine to seniors. Enrollees will not be charged.

— Workplace and individual health insurance plans will cover the COVID-19 vaccine as a preventive service, with no cost sharing. The requirement applies to the vast majority of private plans, which are mandated to cover approved preventive care under the Obama-era Affordable Care Act — even as the Trump administration is trying to overturn that law at the Supreme Court.

— State Medicaid and Children’s Health Insurance plans will have to provide vaccines for free for the duration of the coronavirus public health emergency.

— Doctors, clinics and hospitals vaccinating uninsured people will be able to get paid through a federal fund set up to assist health care providers under financial stress.

The regulations take effect immediately.

A White House-backed initiative called “Operation Warp Speed” seeks to have a vaccine ready for distribution in the coming months. The government is spending billions of dollars to manufacture vaccines even before they receive FDA approval, thereby cutting the timeline for delivery. Officials at the FDA have pledged that the program will not interfere with their own science-based decisions. Vaccines that do not meet the test for approval would be discarded.

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Premiums for Part B & Part D for 2021

Part B – Premium and IRMAA* (*Income-related monthly adjustment amount)

Part B covers 2 types of services

Medically necessary services: Services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice.

Preventive services: Health care to prevent illness (like the flu) or detect it at an early stage, when treatment is most likely to work best.

Some people automatically get Medicare Part B (Medical Insurance), and some people need to sign up for Part B. Learn how and when you can sign up for Part B.

If you don’t sign up for Part B when you’re first eligible, you may have to pay a late enrollment penalty.

Click here for cost of Part B – https://www.medicare.gov/your-medicare-costs/part-b-costs

Part D – IRMAA
All plans must cover a wide range of prescription drugs that people with Medicare take, including most drugs in certain protected classes,” like drugs to treat cancer or HIV/AIDs. Information about a plan’s list of covered drugs (called a “formulary”) isn’t included in this handbook because each plan has its own formulary. Many Medicare drug plans and Medicare health plans with drug coverage place drugs into different levels called “tiers” on their formularies. Drugs in each tier have a different cost. For example, a drug in a lower tier will generally cost you less than a drug in a higher tier.

https://www.medicare.gov/drug-coverage-part-d/costs-for-medicare-drug-coverage/monthly-premium-for-drug-plans

Deloitte: Medicare Advantage plans that don’t embrace telehealth ‘will get left behind’

COVID-19 has dramatically accelerated the adoption of digital health, and a new analysis from Deloitte finds that trend extends similarly to Medicare Advantage (MA) beneficiaries.

Deloitte researchers surveyed executives at MA plans, as well as digital health companies, and found that through April 2020 more MA members used telehealth than did so in all of 2019.

Through April, 26% of beneficiaries said they used telehealth or had a virtual visit for any reason, compared to 13% saying the same across all of 2019.

As open enrollment for Medicare continues, insurers that are embracing digital are getting a leg up on the competition, the analysis found.

“COVID has been a game changer. None of this was table stakes six months ago,” the Medicare sales lead at one MA plan said. “As we go into the next open enrollment, if you don’t have telemedicine, you’re going to hurt.”

Sarah Thomas, managing director of Deloitte’s Center for Health Solutions, told Fierce Healthcare that members are taking notice of plans that operate with an “old-school approach” to technology.

The interest among beneficiaries extends to digital ways to enroll in new plans in lieu of meeting a broker in person, Thomas said.

“There’s a significant and growing portion of people who are beginning to expect to get enrolled virtually,” she said.

The researchers also found that providers, who are critical partners in growing the use of these benefits, are also “surprised” by how effective these tools are.

Deloitte analysts surveyed physicians prior to the pandemic and found that these tools were making their work more efficient and a bit easier. They’re also finding it an effective way to deliver care in many circumstances, Thomas said.

“We have a primary care provider-centric view of technology. That’s our tech strategy,” the chief technology officer at one plan told Deloitte. “We arm our PCPs with as much tech as possible. The best product or tool to engage the seniors are the PCPs.”

The pandemic’s impact on digital health has included insurers’ supplemental benefits that target MA members’ social determinants of health. The Centers for Medicare & Medicaid Services allowed MA plans to make midyear adjustments to their supplemental benefits, which provided the opportunity to offer members a smartphone for virtual visits and other options that harness the virtual space.

RELATED: Why Papa, Humana think it’s crucial to ‘make noise’ about the impacts of loneliness amid COVID-19 

Insurers pointed to several key areas where they’ve focused amid the pandemic: transportation, home drug delivery, food and nutrition and social isolation. All of these get at one of the main challenges under COVID-19: the push for people, especially populations at high risk like seniors, to stay home to avoid exposure.

MA plans are offering transportation benefits to assist members in getting to their doctor’s office or to buy groceries and are also partnering with local food banks and other services to provide food delivery.

In addition, they’re offering programs to provide companionship and help members secure medications from their homes, according to the report.

The demands of the pandemic have taken these concerns from “the back seat to the passenger seat,” according to the report.

“The direction and the emphasis on digital—there is no turning back,” Thomas said. “Health plans that are sort of waiting on the sidelines and hoping to be a fad follower will get left behind.”

Full article – https://www.fiercehealthcare.com/payer/deloitte-medicare-advantage-plans-don-t-embrace-telehealth-will-get-left-behind

Assisted Living for Veterans: Benefits You Didn’t Know Existed

Veterans give their all in the service, yet may find it challenging to resume their civilian lives, especially if they suffer from post-traumatic stress disorder (PTSD). Reintegrating into the community can be a long, hard road.

And even later in life, veterans face an additional hurdle if they need to move into an assisted living facility (ALF): the high cost of care.

Fortunately for veterans and their surviving spouses, there are benefits available to help alleviate the financial burden that comes with long-term care in an assisted living facility.

And see so much more …

https://assistedlivingtoday.com/blog/assisted-living-veterans-benefits-didnt-know-existed/

Medicare Annual Open Enrollment

Medicare annual open enrollment has begun.  This is the time to review all your options, for the choice that best meets your current need. Reviewing items like your out of pocket cost, check with your providers, review your medications. The time is now. We can begin enrollment from October 15th – December 7th. You can reach us, to discuss your options @ 201-644-8502. And you can email us at carrerabrokerage@gmail.com. We can set up either a conference call or virtual meeting whichever you are comfortable with. 

Learn more about Medicare at the link below.