Posts Tagged ‘Medicare Advantage’

Medicare Hospice Benefit

Monday, February 1st, 2016

Medicare Hospice Benefit

Hospice and other end of life issues are not things we often want to talk about. However, being prepared and knowing all your options is a good idea.

We should start by describing hospice. Hospice is a program of care and support for people who are terminally ill. The focus is usually on providing comfort instead of treatment. It is a choice a patient needs to make with their doctor and family. Hospice programs also offer assistance and services to family members during the process of caring for the patient.

If you have Medicare it will cover hospice services. The Medicare hospice benefit covers your care and you shouldn’t have to go outside of hospice to get care (except in very rare situations).

Once you choose hospice care, your hospice benefit should cover everything you need. All Medicare-covered services you get while in hospice care are covered under Original Medicare, even if you were previously in a Medicare Advantage Plan (like an HMO or PPO) or other Medicare health plan.

Medicare Part A (Hospital Insurance) covers Hospice care if you meet these conditions:

Your hospice doctor and your regular doctor certify that you’re terminally ill (with a life expectancy of 6 months or less).

You accept palliative care (for comfort) instead of care to cure your illness.

You sign a statement choosing hospice care instead of other Medicare-covered treatments for your terminal illness and related conditions.

Palliative care means that the medical team will focus on relieving the patient’s pain and any other symptoms, including mental stress. Only your hospice doctor and your regular doctor can certify that you’re terminally ill and have 6 months or less to live.

To start the process you meet with your doctor to discuss all options. Medicare covers a one-time only hospice consultation with a hospice medical director or doctor to discuss your care options and management of your pain and symptoms. This one-time consultation is available to you, even if you decide not to get hospice care.

Medicare will cover the hospice care you get for your terminal illness and related conditions, but the care you get must be from a Medicare-approved hospice program.

Hospice care is can be given in your home. Although depending on your needs and wishes, there are also inpatient programs available. That is one of the things you will discuss with the hospice program (and your loved ones). Together you will create a plan of care that can include any or all of these services:

Doctor services

Nursing care

Medical equipment (like wheelchairs or walkers)

Medical supplies (like bandages and catheters)

Prescription drugs

Hospice aide and homemaker services

Physical and occupational therapy

Speech-language pathology services

Social worker services

Dietary counseling

Grief and loss counseling for you and your family

Short-term inpatient care (for pain and symptom management)

Short-term respite care

Any other Medicare-covered services needed to manage your terminal illness and related conditions, as recommended by your hospice team

You can find out more information at medicare.gov or by calling them at 1-800-Medicare. Hospice specific information and resources are available at https://www.medicare.gov/coverage/hospice-and-respite-care.html

You can also talk to your physician about your options and care available in your area.

This information is meant to inform you of coverage available to you should you need it. Don’t be afraid to talk openly with your family about end of life decisions.

 

Medicare Open Enrollment Starts Today (Oct. 15th)

Wednesday, October 15th, 2014

Medicare Open Enrollment Starts Today (Oct. 15th)

Open Enrollment is happening now. From October 15th to December 7th you can make changes to your Medicare coverage.

What changes can you make?

If you are enrolled in Original Medicare, you can join a Medicare Advantage plan with or without drug coverage. These plans are private companies that are approved by Medicare and give you the services of Original Medicare. If you join a Medicare Advantage plan, you do not need to have a supplement plan (also known as a Medigap policy) and if your Medicare Advantage plan has drug coverage, you will not need a Part D plan.

If you are in a Medicare Advantage Plan, you can switch to another Medicare Advantage plan or drop your Medicare Advantage Plan. If you decide to drop a plan and not switch to another plan, you will be enrolled in Original Medicare.   You should then consider enrolling in a supplement plan to cover the costs that Original Medicare does not pay for and enroll in a Part D plan for drug coverage.

If you are in Original Medicare with a Part D plan, you can stay in Original Medicare and switch your Part D plan.

If you are in Original Medicare and do not have a Part D plan, you can enroll in a Part D plan.

Why You Should Review Your Coverage

It’s important to review your coverage before making a decision. And remember just because your doctor and medications are covered in your Medicare Advantage plan, supplemental plan or drug plan this year doesn’t automatically mean they will be covered in the coming year. Research studies show that Medicare recipients can save money if they review their Part D coverage. Make sure to confirm cost, copays, coinsurance, covered providers, and prescription drugs. Here are a few things to consider:

  • Has your health changed in the last year?
  • Is your current plan still meeting all of your health needs?
  • How much have you paid out-of-pocket in the last year—and for what?
  • How is your plan changing for the coming year? How will that affect your out-of-pocket        costs?
  • Are there better options available to you now?

There are many ways you can get assistance with this process. You can contact Medicare directly at 1-800-MEDICARE or at www.medicare.gov

You can also contact your County SHIP (State Health Insurance Program) by calling 1-800-792-8820 or visit http://www.state.nj.us/humanservices/doas/services/ship/

NCOA (National Council on Aging) also has some useful information and tools. Like Medicare Quick Check, where you can answer some questions and you’ll get advice on choosing a new plan. Find it at https://medicarequickcheck.benefitscheckup.org/medicare-quick-check/?SID=543e7baa3cc91

In November, tune into Aging Insights to hear from the Senior Medicare Patrol of NJ, including Open Enrollment.

News-Open-enrollment-Oct-15th

Medicare Advantage- Beware of scare tactics

Thursday, September 20th, 2012

Medicare Advantage- Beware of scare tactics

What is Medicare Advantage? Medicare Advantage plans are private plans offered by insurance companies to replace your traditional Medicare benefits.

An advantage plan provides all the same benefits as traditional Medicare, such as doctor visits and hospital stays. Some plans may offer extra benefits that are not usually covered by Medicare, such as eyeglasses and hearing aids. Medicare Advantage plans come with a monthly premium that differs depending on the company and type of plan. The Federal Government pays the insurance companies to manage your care under a Medicare Advantage plan, instead of them managing it under traditional Medicare.

There have been some efforts to scare seniors into thinking that the Affordable Care Act (ACA) will change or effect their Medicare Advantage coverage. But you need to know the facts. The Affordable Care Act does not change any benefits guaranteed to Medicare recipients. This includes Medicare Advantage plans. What the ACA does change is the way the Medicare Advantage plans are paid. Starting in 2012, Medicare began reducing the extra government payments to insurance companies for Medicare Advantage plans. The reason for these plans have been made to reduce payments is because there is little evidence that better care was given to anyone on a Medicare Advantage plan. Medicare Advantage plans are eligible to receive bonuses if they provide quality care.

Enrollment in Medicare Advantage plans is low, even here in NJ, leaving some to question, what is the real advantage? Some may think having a commercial insurance company’s name on your card carries more weight than a Medicare card, but just like any commercial insurance plan, there are sometimes more hoops (referrals, prior authorizations) to jump through than there are with traditional Medicare.

What the Affordable Care Act does do for consumers who use Medicare Advantage plans is provide some protections. For example, Medicare Advantage plans are not allowed to charge more for services than traditional Medicare does. The ACA also has provisions to reduce out of pocket costs for patients using high-cost services like cancer treatment or dialysis. Under the ACA, Medicare Advantage plans have also been mandated to limit their administrative costs, as well as their profits. This measure is to ensure that the plans spend 85 % of their money on member benefits (that will start in 2014).

Rumors of Medicare Advantage consumers facing cuts to their benefits due to the ACA are rampant and intended to scare seniors. The truth is, every year the insurance companies are offered the choice to continue operating a Medicare Advantage Plan and to change the services offered under that plan (they are only required to cover what traditional Medicare covers). So, any year, not just this year, Medicare Advantage plans could chose to stop providing optional benefits such as eyeglasses.

So what does this all mean to you, the Medicare recipient? Well, if you are currently in a Medicare Advantage plan, your plan must send you a notice of any changes for 2013 by October 1, 2012. Make sure to read it carefully. Even if you are not currently in a Medicare Advantage plan, all Medicare recipients should go to www.medicare.gov to review both traditional Medicare and Medicare Advantage plans to compare and decide what is best for them. Open Enrollment is October 15 to December 7thand during that period you can decide to stay in the same Medicare Advantage plan you have now, change to a different Medicare Advantage Plan or switch to traditional Medicare. If you chose to switch to traditional Medicare, remember that if you had a Medicare Advantage plan that offered prescription drug coverage you will need to also enroll in a Medicare drug coverage plan and/or buy a Medigap supplemental policy.

 Detailed information about Medicare, Medicare Advantage, Medicare Drug coverage, Medigap plans and Open Enrollment can be found at http://www.medicare.gov/.

 For detailed information about the Affordable Care Act and seniors, visit www.ncoa.org/StraightTalk

For more information about the Affordable Care Act in general, you can visit, http://www.healthcare.gov/law/index.html

Medicare Open Enrollment Period

Monday, August 29th, 2011

Medicare Open Enrollment

Medicare Open Enrollment is October 15, 2011 – December 7, 2011

Did you know new prescription drug and health plan coverage choices are offered every year? Every fall, all people with Medicare should review their current coverage.

During the Fall Open Enrollment you can change how you receive your health coverage and add, change or drop drug coverage. You can make as many changes as you want. Changes made during the Fall Open Enrollment take effect January 1, 2012. If you don’t want to make any changes you don’t need to do anything, your current coverage will stay the same.

What you can do:

  • Change from Original Medicare to a Medicare Advantage Plan.
  • Change from a Medicare Advantage Plan back to Original Medicare.
  • Switch from one Medicare Advantage Plan to another Medicare Advantage Plan.
  • Switch from a Medicare Advantage Plan that doesn’t offer drug coverage to a Medicare Advantage Plan that offers drug coverage.
  • Switch from a Medicare Advantage Plan that offers drug coverage to a Medicare Advantage Plan that doesn’t offer drug coverage.
  • Join a Medicare Prescription Drug Plan.
  • Switch from one Medicare Prescription Drug Plan to another Medicare Prescription Drug Plan.
  • Drop your Medicare prescription drug coverage completely.

Medicare Advantage Disenrollment Period 2012: January 1, 2012 – February 14, 2012

During the Medicare Advantage Disenrollment Period (MADP) you can switch from a Medicare private health plan (also known as a Medicare Advantage plan) to Original Medicare. Regardless of whether the Medicare private health plan had drug coverage, you can join a stand-alone prescription drug plan, but you are not required to. For example if you have a Medicare Advantage Plan with drug coverage you can change to Original Medicare and a prescription drug plan or Original Medicare and no drug plan.  Changes made during the MADP go into effect the first day of the following month.

What you can do:

  • If you are in a Medicare Advantage Plan, you can leave your plan and switch to Original Medicare.
  • If you switch to Original Medicare during this period, you will have until February 14 to also join a Medicare Prescription Drug Plan to add drug coverage. Your coverage will begin the first day of the month after the plan gets your enrollment form.
    Note: During this period, you can’t do the following:
  • Switch from Original Medicare to a Medicare Advantage Plan.
  • Switch from one Medicare Advantage Plan to another.
  • Switch from one Medicare Prescription Drug Plan to another.
  • Join, switch, or drop a Medicare Medical Savings Account Plan.

Choosing Medicare coverage can be confusing, but understanding the different parts of Medicare and your Medicare coverage choices can help.  You can use the Medicare Plan Finder https://www.medicare.gov/find-a-plan/questions/home.aspx to help you make a decision about the best plans for you.

 If you would like assistance with this process please contact a State Health Insurance Assistance Program (SHIP). To find a SHIP program in your area visit: http://www.state.nj.us/health/senior/sashipsite.shtml

Affordable Care Act (ACA) Facts: Part 2 in a Series

Thursday, February 24th, 2011

Affordable Care Act (ACA) Facts: Follow this Series

There is a lot of speculation and discussion about what affect health care reform legislation, the Affordable Care Act (ACA), will have on seniors and more specifically, Medicare. We decided to do a series of blog posts about the facts; this is our second post, so please see Fact # 1 in a post dated, Feb 8, 2011.

Fact # 2 The ACA will reduce Medicare spending growth, extend Medicare solvency and is projected to reduce the budget deficit.

While Medicare spending will continue to grow, over the next 10 years the healthcare law will slow the overall rate of growth. Average spending per person will grow at about 2% per year, according to the Congressional Budget Office (CBO) this is compared to the current rate of 4% per person per year. This slight decrease will be a result of reductions in waste, fraud and abuse.  The CBO also projects that the ACA will save Medicare about $400 billion over 10 years and will extend the solvency of the Medicare Trust Fund until 2026.

What you need to know:

In 2011, the ACA will slow payment increases that are made to Medicare providers such as, hospitals, nursing homes and home health agencies. Please note that doctors are not included in that group. The ACA does not reduce payments to your primary care doctor.

Also in 2011, payments to Medicare Advantage (MA) will be reduced. Approximately 25% of seniors are enrolled in MA plans, HMOs or PPOs offered by private insurance companies, the other 75% have traditional Medicare. The ACA will gradually lower payments made to MA plans, which on average cost 13% more than original Medicare. Another change that ACA makes to Medicare Advantage (MA) plans is that those plans will not be able to charge you more than what you would pay if you were on original Medicare for services such as kidney dialysis, chemotherapy, or skilled nursing home care.

Because of these laid out in the Law, MA plans may cut some of the extra benefits they offer that are not covered by traditional Medicare and some may increase their premiums. Please note that MA plans cannot cut any basic benefits under Medicare, such as doctor visits and hospital care. You will also have the same right to switch out of your MA plan to original Medicare, the new law will not affect your right to Medicare benefits.

Another way that Medicare savings will occur according to statements in the Affordable Care Act, is for higher income individuals to pay higher prescription drug premiums. This will affect about 5% of Medicare recipients in 2011, single people with incomes above $85,000 and couples with adjusted gross incomes above $170,000.

The ACA states that in 2014 a Payment Advisory Board will be created. This board of experts will recommend specific ways to reduce Medicare costs without cutting benefits or increasing out-of-pocket costs.

Information in this blog was gathered from the Affordable Care Act,  Congressional Budget Office, Centers for Medicaid and Medicare and the National Council on Aging.

For more information check out the following links:

A brochure from Medicare:

http://www.medicare.gov/Publications/Pubs/pdf/11467.pdf

Webpage from the National Association of States United for Aging and Disabilities (NASUAD):

http://www.nasuad.org/affordable_care_act/nasuad_materials.html

Answers from the National Association of Area Agencies on Aging (n4a):

http://www.n4a.org/advocacy/health-care-reform/

Straight Talk for Seniors from the National Council on Aging:

http://www.ncoa.org/public-policy/health-care-reform/straight-talk/