Category

Medicare

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.

Dental Information For Those On Medicare

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.

 

Medicare 101 Made Easy

Learn About Medicare

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.

Events

Saturday, October 12th – 11am to 12pm

Ridgefield Public Library
527 More Avenue
Ridgefield, NJ 07657

Thursday, October 17th – 1:30pm to 2:30pm

Saddle Brook Library
340 Mayhill Street
Saddle Brook, NJ 07663

Saturday, October 26th – 4pm to 5pm

Hawthorne Public Library
345 Lafayette Avenue
Hawthorne, NJ 07506

Saturday, November 2nd – 11am to 12pm

Ridgefield Public Library
527 Morse Avenue
Ridgefield, NJ 07657

Saturday, November 21st – 6pm to 7:30pm

Hawthorne Public Library
345 Lafayette Avenue
Hawthorne, NJ 07506

Download The Event Times Here

Fraud Alert – Genetic Testing Medicare Scam

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 here

Re-admissions penalty doing little to slow the spinning of hospitals’ revolving doors

Author 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.

WHAT’S THE IMPACT

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.

THE LARGER TREND

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.