Oral Health
The House of Representatives passed H.R. 3, a bill that would lower prescription drug prices and use the savings to add an oral health benefit to Medicare. If you have questions on what a Medicare dental benefit would entail, check out our FAQ about adding an oral health benefit to Medicare Part B. You can access earlier oral health resources on this topic. The Miami Herald also published a story about the difficulties older Florida residents facebecause of a lack of oral health coverage.
If you will be entering the Medicare program or have been on Medicare already and would like to use your benefits, it can be over whelming.
Deciding when do I apply for Part A, Part B, Part C & Part D.
What does it all mean? Your choices about your health care is very important and to make an educated decision can be confusing.
Come to explore what your options may be and get answers to questions you may have. There are several meetings scheduled.
Have you heard about the latest scam? Scammers are offering “free” genetic tests and claiming Medicare will cover it — so they can get your Medicare Number and use it to commit fraud and identity theft. They’re targeting people through telemarketing calls, health fairs, and even knocking on doors.
Only a doctor you know and trust should order and approve any requests for genetic testing. If Medicare is billed for a test or screening that wasn’t medically necessary and/or wasn’t ordered by your doctor, the claim could be denied. That means you could be responsible for the entire cost of the test, which could be thousands of dollars.
Learn more hereAuthor of original content: Jeff Lagasse
Original article found here.
Every American hospital has two front doors: The real one, and an imaginary revolving door. Any patient who winds up back in the hospital within a few weeks of getting out travels through that imaginary door, and the more of them there are, the more money the hospital stands to lose from the Medicare system.
This readmission penalty aims to spur hospitals to prevent unnecessary costly care, but a new study shows that after several years of rapid improvements in re-admissions, the readmission penalty program may be spinning its wheels more than it’s slowing the spinning of the revolving hospital door.
Writing in the journal Health Affairs, a team from the University of Michigan reported findings from their analysis of data from nearly 2.5 million Medicare patients. They focused on those who had hip or knee replacement surgery before and after penalties affecting these operations were announced.
The study shows the readmission rate for these patients had already started dropping by the time the idea of readmission penalties was announced as part of the Affordable Care Act in 2010. Soon after that, the re-admissions rate for these surgical patients started dropping faster — even though the penalties announced in the ACA did not apply to surgical patients.
The rate kept dropping rapidly for several years — even though hospitals weren’t getting penalized yet for hip and knee replacement-related re-admissions. But that improvement started to slow down.
After the government announced in late 2013 that penalties would expand to hip and knee replacement, the rate of re-admissions for these patients kept dropping, but at nearly half the rate. In other words, improvements in surgical re-admissions slowed to the same pace they had before any penalties were announced in 2010.
At the same time the readmission rates were changing, the average cost of caring for a Medicare hip or knee replacement patient did too, the study showed. In fact, it dropped by more than $3,000 from 2008 to 2016.
And hip and knee patients’ chance of heading home from the hospital, rather than to a skilled nursing facility or other setting, has increased over that time. So has the likelihood that they will have assistance from a home health aide when they get home.
The authors contend that the same efforts that hospitals may have launched to prevent readmission of medical patients may have extended to these surgical patients. These might include care coordination programs and phone check-ins with recently discharged patients, or better patient education about home care or changes to their medications.
The Hospital Readmission Reduction Program, or HRRP, still carries large penalties — up to 3% of what a hospital earns for certain Medicare patients. It has also expanded to include more conditions, including heart bypass surgery and more types of pneumonia, including those with sepsis.
But researchers say that adding more conditions to the program is not likely to result in much more readmission prevention or cost savings.
In the end, some re-admissions are inevitable, they said, and trying to drive rates lower through penalties may mean some patients who should have been readmitted won’t be.
Instead, the authors suggest that more use of bundled payments — where Medicare sets a defined amount of money it will pay for the episode of care surrounding a surgical patient’s operation — could produce better results. This is because bundled payments ensure hospitals focus on costs and complications around the entire episode of care, not just one metric like re-admissions.
There’s been ongoing debate regarding the equity of the HRRP. For example, safety net hospitals have long held they are unfairly penalized for their readmission rates under HRRP’s current performance model because it doesn’t account for social risk factors that put these patients at risk for readmission.
Author of original content: Megan Leonhardt
Original article found here.
Let’s set the record straight: Not everyone needs life insurance. It’s more than likely that you’ll start thinking about needing a policy as you hit major life milestones, whether that’s starting a business, getting married or having your first child.
Young and single 20-somethings probably haven’t thought much about life insurance, and that’s OK. If you’re 25 with no debt you probably don’t need a life insurance policy, Ginty says.
But if you’ve co-signed a student loan with your parents, you may want to consider getting a life insurance policy because you have a financial obligation that could impact your parents. If you suddenly died, some private lenders have clauses in their contracts that require the loan balance to be repaid immediately. Your family may need a life insurance payout to cover that debt.
Or perhaps you help support other family members — siblings, parents or grandparents. What happens to them if you aren’t capable of covering their expenses? Do they depend on your income? If so, then taking out a policy is a good bet.
The same is true if you’re a business owner and took out a loan to fund your company. Not only do some small business loans require you to have life insurance coverage, but you need to ask yourself what happens to your employees and your company if you should suddenly die? In most cases, there will be expenses that will need to be wrapped up or perhaps a portion of the loan that will need to be repaid.
Getting married often prompts couples to have hard financial conversations, and it’s not a bad idea to discuss life insurance while you’re at it. You may want to consider getting a policy if your spouse depends on your income to fund your shared expenses (or vice versa).
Financial coach Dave Ramsey recommends life insurance for married couples in situations where they, individually or jointly, racked up a lot of debt. If you live in a community property state where assets and debts are divided equally, your widow could be stuck trying to pay off all your joint debt if you died. That includes residents of Alaska, Arizona, California, Idaho, Louisiana, Nevada, New Mexico, Texas, Washington and Wisconsin.
Plus, if you plan to have kids one day, you may want to purchase life insurance before you become a parent. Your life insurance rate is based on your age, medical history and lifestyle choices (do you smoke, for example). It’s generally easier to get a cheaper policy if you’re young and relatively healthy.
This is especially true for women. Pregnancy is sometimes considered a pre-existing condition and may complicate the process of getting life insurance. And in some cases, a pregnancy may trigger lasting health effects for women, which again, may lead to higher insurance rates.
Once you have children, you almost always need life insurance. If something should happen to you or your co-parent, a life insurance policy will help your family handle expenses. Dave Ramsey recommendsonce you have kids to get a policy that is worth 10 times your annual pay.
You now know when to buy, but actually figuring out what to buy can still be stressful and confusing. That’s why it’s important to learn the basics of how to buy life insurance so you’re more in control when you finally pull the trigger.
“As an educated consumer, you always make a better decision when it’s not fear based,” Ginty says. You also can choose to work with an insurance broker or financial advisor who can help you compare rates from multiple companies, giving you options.
There are two basic types of life insurance: term and permanent (whole life insurance is an example of this type of policy). When you buy a life insurance policy, you can specify the amount that will be paid out if you die (called the death benefit). Your monthly payment is the “premium.” As long as you keep up with the premiums, your insurer will pay your beneficiaries when you die, usually as a lump sum.
Term life insurance is pretty much exactly what the name implies — it’s insurance that covers you for a specific period of time, typically 10, 20 or 30 years. If you die while the policy is in place, you’re covered. Once the term expires, you’re no longer covered.
Permanent life insurance — which includes universal life, variable life and whole life — covers you throughout your life. Unlike term life, which is pure insurance that simply offers a payout if you should die, permanent policies, such as whole life, essentially create a savings account for you where you can earn a minimum guaranteed interest or a dividend. These earnings are generally tax-deferred and referred to as the “cash value.” Over time, this builds up and you can borrow against it, (but you’ll typically need to repay it) or even use it to cover your premiums.
Yet those extra perks on permanent policies also increase the price. They can cost up to 10 times more than term, which can lead to people missing a payment or abandoning them all together. About 45% of people surrendered their policies within the first 10 years, according to a comprehensive study from the Society of Actuaries.
That’s why, for most people, term life insurance is the way to go, Ginty says. For example, a 30-year-old, relatively healthy woman who’s considering buying a $500,000 policy will likely pay $35 a month for a 30-year term life policy, as opposed to $455 a month for whole life coverage, Ginty calculates.
When it comes to term life, experts advise consumers to take out level term life insurance, which guarantees you pay the same rate throughout the life of the policy. And if you’re worried about being covered later in life, you usually can convert a term policy into a permanent policy up until a year before it expires, if that’s of interest, Ginty says.
You’ve settled on the type of insurance policy. Now how much coverage do you need? Most standard policies range from $250,000 to $1 million. How much you need depends on how the money will be spent. Do you need the policy to help pay off any funeral costs? Your mortgage? Fund your children’s college education? Or maybe it’s simply to help cover day-to-day expenses, such as childcare, for a certain period of time. Once you decide on how the money will be spent, you can determine how much insurance you need.
The non-profit insurance information organization Life Happens offers several calculators that can help if you’re not quite sure.
Some employers will offer life insurance as part of your benefits package, which is great. These policies are good for those who need little to no life insurance. But they’re not usually portable, which can be a huge drawback. Your policy ends when your job ends, so if you quit or are let go, you’ll be left with zero coverage.
“I always think of the work policy as the cherry on top, it’s extra” Ginty says. “It’s better than nothing if you’re struggling.”
Navigating life insurance policies and salespeople can be complicated, but that’s not a good excuse for inaction. Many people think you need to know a lot about finance in order to successfully buy life insurance, but that’s not true, Ginty says. “You just need to rely on your gut instincts,” she says. “If it doesn’t feel comfortable, it’s probably not the right fit for you.”
Carrera Brokerage is here to help with your concerns and options.
Resources from the National Association of Insurance Commission (NAID)
Long Term Care can be confusing. Here is some information from the NAID.
Reviewing these 10 items can be helpful when considering your options.
The PDF attached below shows some great examples of how Medicare works with other types of coverage, who should pay your bills first, and where to get more help.
Representatives Katie Hill (D-CA-25) and Brian Babin (R-TX-36) recently introduced The Medicare Part B Fairness Act (H.R. 1788). The bill would limit the amount and duration of the Part B Late Enrollment Penalty (LEP). As well as expand the Special Enrollment Period for people with employer-sponsored coverage to other types of pre-Medicare coverage.
To amend title XVIII of the Social Security Act to limit the penalty for late enrollment under part B of the Medicare Program to 15 percent and twice the period of no enrollment, and to exclude periods of COBRA, retiree, and VA coverage from such late enrollment penalty.
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