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Medicare

How do Medicare Advantage Plans work?

Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are an “all in one” alternative to Original Medicare. They are offered by private companies approved by Medicare.  If you join a Medicare Advantage Plan, you still have Medicare.  These “bundled” plans include  Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance), and usually Medicare drug coverage (Part D).

Find Medicare Advantage Plans in your area.

Covered services in Medicare Advantage Plans

Most Medicare Advantage Plans offer coverage for things Original Medicare doesn’t cover, like some vision, hearing, dental, and fitness programs (like gym memberships or discounts). Plans can also choose to cover even more benefits. For example, some plans may offer coverage for services like transportation to doctor visits, over-the-counter drugs, and services that promote your health and wellness. Plans can also tailor their benefit packages to offer these benefits to certain chronically-ill enrollees. These packages will provide benefits customized to treat specific conditions. Check with the plan before you enroll to see what benefits it offers, if you might qualify, and if there are any limitations.  Learn more about what Medicare Advantage Plans cover.

Rules for Medicare Advantage Plans

Medicare pays a fixed amount for your care each month to the companies offering Medicare Advantage Plans. These companies must follow rules set by Medicare.

Each Medicare Advantage Plan can charge different out-of-pocket costs. They can also have different rules for how you get services, like:

  • Whether you need a referral to see a specialist
  • If you have to go to doctors, facilities, or suppliers that belong to the plan for non-emergency or non-urgent care

These rules can change each year.

Costs for Medicare Advantage Plans

What you pay in a Medicare Advantage Plan depends on several factors. In many cases, you’ll need to use doctors and other providers who are in the plan’s network and service area for the lowest costs. Some plans won’t cover services from providers outside the plan’s network and service area. 

Learn about these factors and how to get cost details.

Drug coverage in Medicare Advantage Plans

Most Medicare Advantage Plans include prescription drug coverage (Part D). You can join a separate Medicare Prescription Drug Plan with certain types of plans that:

  • Can’t offer drug coverage (like Medicare Medical Savings Account plans)
  • Choose not to offer drug coverage (like some Private Fee-for-Service plans)

You’ll be disenrolled from your Medicare Advantage Plan and returned to Original Medicare if both of these apply:

  • You’re in a Medicare Advantage HMO or PPO.
  • You join a separate Medicare Prescription Drug Plan.

How Medicare Supplement Insurance (Medigap) policies work with Medicare Advantage Plans

Medigap policies can’t work with Medicare Advantage Plans. Learn about your options related to Medigap policies and Medicare Advantage Plans.
Click here for statistics – Click Here
For More Medicare information go to – Medicare.gov

Center for Medicare & Medicaid – CMS Fraud Prevention Initiative

The federal government has made important strides in reducing fraud, waste and improper payments across the government. The Affordable Care Act provided additional resources and tools to enable the Centers for Medicare & Medicaid Services (CMS) to expand its efforts to prevent fraud, waste and improper payments. The same innovative tools are being used to further enhance collaboration with our State and law enforcement partners in detecting and preventing fraud.

Using tools provided under the ACA, CMS has used a multifaceted approach, ranging from provider screening to the use of predictive modeling technology similar to that used by credit card companies that has saved nearly $60 billion during 2013-15. This equates to an average savings of $12.40 for each dollar spent on these program integrity efforts.

Guard Your Card Campaign

The CMS “Guard Your Card” campaign tells people how they can protect themselves against fraud by:

  • Never giving out their Medicare or Social Security Number to anyone except those you know should have it.
  • Reporting any suspicious activities like being asked over the phone for their Medicare/Social Security number or banking information. Medicare will NEVER call you uninvited for this information.
  • By checking their billing statements and reporting suspicious charges. Using a calendar to track doctor’s appointments and services helps quickly spot possible fraud and billing mistakes. Check claims early by logging into mymedicare.gov.

Please report suspicious activities by calling 1-800-MEDICARE (1-800-633-4227).

Help Prevent Fraud – Click Here
The 4Rs on Fighting Fraud – Click Here

Extra Help with Part D

What is Extra Help with Medicare prescription drug plan costs? Anyone who has Medicare can get Medicare prescription drug coverage. Some people with limited resources and income also may be able to get Extra Help with the costs — monthly premiums, annual deductibles, and prescription co-payments — related to a Medicare prescription drug plan.

Click here for more details.

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

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.  

Click Here For More Information

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

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

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.

What is Medicare?

Medicare is a federal program that offers health insurance to American citizens and other eligible individuals. The program is often called Original Medicare. It has two parts — Part A and Part B.

What does original Medicare cover?

Part A – Part A covers in-patient hospital and skilled nursing care.

Part B – Part B covers doctor visits and outpatient care.

Choosing private plans may provide additional coverage.

Part C – Medicare Advantage plans (Part C) combine Part A and Part B coverage. They often include Part D coverage and other benefits you don’t get with Original Medicare, e.g. glasses, dental, meals, OTC items and so much more. Some plans cost as low as $0 for a monthly premium.

Part D – Medicare prescription drug plans (Part D) help pay for medications. You can get a standalone Part D plan or get a Medicare Advantage plan that includes drug coverage.

Medicare Supplement

Medicare supplement insurance (Medigap) helps pay some or all costs not paid by Original Medicare (deductibles, copays and coinsurance).

Many questions and things to consider. Your health, your budget, your preferences. Have more questions.

  1. When should I enroll for Medicare?
  2. What if I work past age 65?
  3. I have employer coverage, do I need to enroll with Medicare?

If you would like to speak with a licensed and certified professional and receive a FREE review Medicare Programs available do not hesitate to contact us.

Protect Yourself From COVID-19 Scams

You may already be taking steps to protect your health during the COVID-19 emergency. Be sure to also protect your identity from scammers by guarding your Medicare Number.

It’s easy to get distracted and let your guard down during these uncertain times. Scammers may try to steal your Medicare Number. They might lie about sending you Coronavirus vaccines, tests, masks, or other items in exchange for your Medicare Number or personal information.

Protect yourself from scams:

  • Only share your Medicare Number with your primary and specialty care doctors, participating Medicare pharmacist, hospital, health insurer, or other trusted healthcare provider.
  • Check your Medicare claims summary forms for errors.

More Info

Visit Medicare.gov/fraud for more information on protecting yourself from fraud and reporting suspected fraud.

Sincerely,

The Medicare TeamNote: You can learn more about COVID-19 and your Medicare coverage on Medicare.gov.