Medicare Blog: Moorestown, Cranford NJ

What would "Medicare for All" Mean for you?

5/2/2019

Since this is such a politically-charged topic, I try my best to steer clear of the discussion.

However as we get closer to the 2020 election it is important that everyone starts to get educated on the "Medicare For All" proposals that are being discussed.

KFF.org released an article last week that provides a nice summary of each of the options being discussed, which range from a complete Single Payer Plan (everything is free for everyone) to a public option for the ACA Plans, to Medicare Buy-In Option. The KFF article provides a lot of detail, and I have just provided my thoughts below.

Medicare-For-All Single Payer; e.g. Sanders Plan - S. 1129

In theory, this sounds great. Free Insurance for everyone. No Premiums. No Cost-Sharing.
In reality, the costs for such a dramatic change to the healthcare system would be astronomical (most projections show $30 Trillion +).
This Plan would also completely replace the health insurance for the 180 million people who currently have Private Insurance Plans (majority of which are satisfied with their plans).
Additionally, this plan would completely replace the current Medicare system. What impact would this have on the current Medicare beneficiaries who are generally very satisfied with their coverage?

Public Plan through ACA Marketplace; e.g. Cardin's Plan - S. 3

This Plan would provide a Public (Government run) Insurance Plan that would be available in the ACA Marketplace.
This Plan would leverage the Medicare Platform/rules.
Based on the current Medicare system (without adding all of these incremental millions of pre-65 individuals), The Medicare Trustees Report estimates the depletion of the Hospital Trust Fund by 2026.
By adding incremental millions of people (in addition to the 10,000 people per day turning 65) onto the Medicare system, this would likely create additional financial strain on the Medicare system. What impact would this have on the current Medicare beneficiaries who are generally very satisfied with their coverage?

Medicare Buy-In Options, e.g. Stabenow's Plan S. 470

This Plan would provide a "buy-in" option into the current Medicare system starting at age 50.
In theory, this is also an interesting option that would provide indidviuals an option to buy-in to Medicare at a younger age than 65.
Similar to the Public Plan through the ACA Marketplace, this would likely create additional financial strain on the Medicare system. What impact would this have on the current Medicare beneficiaries who are generally very satisfied with their coverage?

What Should we Do?
I completely agree that our Health Care system is flawed in this country and we need some significant improvements. Some key areas, I believe we need to address are below:

Cost Transparency - anyone who has ever tried to decipher an EOB (Explanation of Benefits) can appreciate the horrendous lack of clarity and transparency with regards to Medical costs in our country. The billed amounts, approved amounts, etc. create confusion and stress for anyone affected by high medical bills. Trying to understand (and potential shop) the pricing for a Procedure prior to scheduling it, can be extremely frustrating. Bottom line, we need better pricing transparency. Fortunately, Medicare released a Procedure Price Lookup tool at the end of 2018 to start providing more clarity around pricing. My initial review of the tool back in February 2019 seemed to indicate the pricing data in the tool is not accurate when compared to actual Medicare claims data found on myMedicare.gov. I am hopeful that the data will improve over time and we will be able to get more accurate pricing information.
Prescription Drug Costs - My frustration peaks when I think about Prescription drug costs in this country. Folks with chronic conditions are essentially held hostage to the costs of their medications, even those medications that have been around nearly 100 years (such as Insulin for diabetics). This country does need improvements to the entire Supply Chain and Pricing Practices for Drugs including the ability to negotiate with Drug Manufacturers.
Stabilize the ACA Marketplace- The Affordable Care Act never realized its goal of truly 'Affordable" healthcare. It did improve access to Healthcare to 10 million+ individuals who did not have Health Insurance prior. Thus, the ACA should NOT be repealed; it needs to be stabilized with a reintroduction of the ACA Mandate penalty which helps keep health people in the health insurance pool (which helps keep premiums more stable across the board). Also, there are several proposals that would create high-risk pools backed by the government which would help to cap the exposure in high-claimant situations. High-claimants (less than 20% of people) make up 80+% of healthcare costs in this country. These high-risk pools would help address these costs so that the premiums can be kept stable across the board.

This is by no means a fully comprehensive Plan. However, I believe these are some of the key areas that we need to focus on to improve our Health Care system.

With any proposal you study, be sure to ask yourself... What impact would this have on the current Medicare beneficiaries (who are generally very satisfied with their coverage)?

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Medicare will not cover these expenses

4/4/2019

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Generally speaking, Original Medicare with a Medicare Supplement is the best Medical Coverage most people will ever have. For example, if you have a Plan G Medicare Supplement, the only Medical out-of-pocket Exposure for Medicare covered services is the Part B deductible ($185 in 2019).

However, there are certain services that are not covered by Medicare, which we frequently get questions on.

Dental, Vision, and Hearing - Original Medicare does not provide Dental, Vision or Hearing coverage. If it is a medically necessary procedure (e.g. Glaucoma, Wet Macular Degeneration, Cataracts, Diabetes related vision issues), these would be covered by Medicare Part B. But, for basic dental, vision, and hearing services, these are not covered by Medicare. The average Medicare Beneficiary spends about ~$922 / year on Dental expenses alone. Some individuals choose to self-insure for this Coverage, while others continue to prefer to have actual Dental Insurance (or Vision or Hearing). Here is a link to more information about a Dental, Vision, and Hearing option from Manhattan Life, and also a Dental option from Delta Dental (in NJ).
Medical Expenses during International Travel - Unfortunately, Original Medicare does not provide any coverage while you are traveling Internationally. There are certain Medicare Supplements (e.g. Plan C, F, G, N) that provide a minimal level of Medical Coverage for Foreign Travel Emergencies. These plans provide a lifetime maximum benefit of $50,000. There is a $250 deductible, and then 80/20 coverage after the deductible. This coverage CANNOT be used for Medical Evacuation, which could cost $30,000-$100,000+ to be transported back to the United States for care. For individuals that would like additional International coverage, here is a link to some reasonable options from GeoBlue (a Blue Cross Blue Shield Company).
Long-Term Care Expenses - Medicare Part A will cover Skilled Nursing Care, if you are transferred from the hospital (after a 3-day admitted stay in the hospital) to a Skilled Nursing Facility. This is NOT long-term care (or custodial care). This is basically like rehab (e.g. after a knee replacement). Long-Term care is NOT covered by Medicare, and about 75% of people will need some form of Long-Term (or Custodial Care) as they get older. Traditional Long-Term Care Plans have gotten very expensive and they are generally "Use It or Lose It" benefits. There are some hybrid options that are now available which blend LTC benefits with Return of Premium and/or Life Insurance benefits so the premiums are not "lost" if you don't use the LTC benefit. You can find more info and request a quote here for LTC benefits.

This is not a comprehensive list of everything that is not covered by Medicare. Rather these are just some of the key areas we get questions about.

A few months ago, Medicare released a new FREE app called "What's Covered" which is a great tool to see what is and what is not covered by Medicare.

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Don't Pay that Bill!

2/21/2019

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Let me start this article with a couple of disclaimers:

The examples mentioned in this article are specific to individuals that are on Original Medicare with a Medicare Supplement. (These examples are not applicable for individuals who have a Medicare Advantage Plan.)
This article is not intended to generalize ALL Medical Providers to say they all bill incorrectly. However, we are seeing an increased number of billing issues in the last several months and it is time that we bring some more attention to these Provider billing issues.
We understand errors do happen, but the frequency/volume seems to be increasing and we are concerned that some beneficiaries are probably just paying these incorrect bills (thinking they owe the amounts) without even questioning them.

Over the past several months, we have seen an increased number of Provider billing issues. Medicare Insurance is already quite complex and if Providers are billing incorrectly, this can create additional angst and financial stress for Medicare beneficiaries. Additionally, there are a certain percentage of individuals who just pay these incorrect bills (because they think they really owe them) and never know that they were erroneous bills.

Three recent examples that will be highlighted are summarized below.

Provider Billing the Wrong Plan
Provider Billing an Old Plan
Provider Over-billing

The first example is a situation in which one of our clients received a bill and an Explanation of Benefits from their Insurance carrier showing that a Claim was denied and the individual owed the Provider $135 for the doctor's visit.

This client happens to have a Medicare Supplement Plan G, so they are responsible for the Part B deductible ($183 in 2018). So, my first question is always "Did you already meet the Part B deductible?" If the individual didn't reach the Part B deductible yet, than it would be conceivable that they could owe $135 for the doctor's visit. However, the client confirmed they had already reached the Part B deductible for the year.

The next step of Troubleshooting is to get a copy of the bill and/or Explanation of Benefits (EOB). In this case, the client had the EOB handy so they emailed us a copy of the EOB (see image above).

The language on the EOB stated that the claim was "DENIED", which is unusual. If Medicare pays for a service, the Medicare Supplement MUST pay its portion of the service.

However, after reviewing further, we noticed the MEMBER ID that was billed by the Provider's office was the Member's Part D Drug Plan. Therefore the Part D Plan denied the claim because Part D Plans do not cover doctor's visits.

The Provider office incorrectly billed the Part D Drug Plan instead of billing Medicare.

For all patients that have original Medicare with a Medicare Supplement, the Provider should NEVER be billing the Supplemental carrier. The Provider just needs to bill Medicare. Medicare will pay the Provider its portion of the bill, and then Medicare will send the remainder of the Bill to the Secondary/Supplemental carrier to pay its portion of the bill. If there is any remaining charges (e.g. if the Part B deductible has not been met yet), the Provider will send a legitimate bill to the Patient.

After explaining this error to the Provider, the Provider sent the bill to Medicare and they payments were resolved by Medicare and the Supplemental Carrier. Our client owed nothing.

The second example deals with another client who also has a Plan G Medicare Supplement. This client already reached her Part B deductible ($183 in 2018), and still received a bill for $57.15. The bill indicated "CLAIM DENIED" by "AETNA HMO EVICORE".

This client does not have an HMO Plan. The client has Original Medicare and a Medicare Supplement.

The bill looks like the Provider billed Medicare correctly, but then the Provider sent another bill to a carrier "Aetna HMO Evicore", which is not the correct behavior. With a Medicare Supplement, Medicare sends the remainder of the bill to the Secondary/Supplemental carrier to pay its portion of the bill. In this case, the Provider attempted to bill the Insurance company based on an old Plan that the Patient no longer has. The reason the CLAIM was denied is because the Plan that was billed is no longer valid for this Patient.

After following up with the Provider, the client was told the claim would be reprocessed and not to worry about the bill.

The third example is the most concerning. One of my Medicare Supplement Plan G clients recently received a medical bill from 2018 for $487.96.

How could this be??? The Part B deductible is only $183. So even if the individual had not reached the Part B deductible (which they already had), the highest bill they should have received in 2018 was $183.

After further review of the bill and verification with the Medicare Supplement carrier, we can see that Medicare actually only approved about $95 of the $602 billed amount. Additionally, Medicare paid its portion of the bill ($74) and the Supplemental carrier paid its portion of the bill ($19). Thus the Provider has been fully compensated for the services provided based on the Medicare approved rates.

The Provider is not allowed to balance bill a patient that has Original Medicare. If Medicare only approves $95, the Provider cannot bill the patient the additional $487.96!!

Unfortunately, this case is still not resolved. The client tried calling the Provider's office several times with over an hour wait time. The client tried calling their doctor as well and was not able to get the billing issue resolved. The next step is for the client to file a complaint with Medicare which should help drive resolution to this issue.

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MyMedicare.gov - Another great resource

2/12/2019

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Medicare is working hard to deliver technology solutions that will provide valuable information to Medicare Beneficiaries.

Just a couple of weeks ago, a new Mobile Application was delivered that provides information about "What's Covered" on Original Medicare.

This article is about a streamlined version of MyMedicare.gov that was released a few months ago. This article is not an entire user guide, rather it just highlights some of the key functions that are available so you can take advantage of the tool.

If you are enrolled in Medicare, myMedicare.gov is a great resource that you can use for a lot of functions. If you have not created an account yet, you will need to register first.

After you register / login, you will see a home page dashboard that looks something like this.

There are a bunch of neat functions and information in this Portal. I will highlight four areas that are important:

General Account Information
View, Print, Order Medicare Card
Claims Information
Blue Button

General Account Info

General Account information provides info about:

Medicare Part A Effective Date
Medicare Part B Effective Dates
Which Part D Drug Plan (if you are currently enrolled)
Which Medicare Advantage Plan (if you are enrolled)

There is also information about notifications/messages that may be available in your account.

Request new ID Card

2. View, Print or Order a new ID Card
The Portal allows you to view your current Medicare ID card. This is a great tool if you lost your ID card and you need your information to take to a doctor's appointment. You can print the ID directly from the Portal. You can also order a new ID Card to be mailed to your home.
Another nice feature allows you to print a temporary ID card for your Part D Plan too!

3. Claims Data
This is one of my favorite features of the Portal. You can query up to 36 months of prior Claims history which provides incredible amounts of detail about the Medicare services that you used over the last 36 months. You can see every claim that has been filed with Medicare, how much was Charged, how much Medicare approved, etc for each service. You can also see the diagnosis codes for every service that was billed to Medicare on your account.

Claims Results Details

4. Blue Button
The Portal provides a "Blue Button" function that allows you to download all the information to a PDF or TXT file. If you are looking for a clean version of your Claims report that you can review, the PDF version is pretty nice. If you are looking to upload your Claims data into a third-party tool / application, you can use the .txt version.

Blue Button Report - customization options

In general, myMedicare.gov is a great tool for Medicare beneficiaries to access all the information related to their Medicare usage.

If you haven't registered yet, I recommend you take a look when you get 5-10 minutes.
https://www.mymedicare.gov/

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Medicare "What's Covered" App

2/5/2019

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Medicare recently released a new mobile application called "What's Covered" which has some very interesting information.
You can download the application from the Apple App Store (Apple Devices) or Google Play (Android Devices).

If you are a Medicare beneficiary, Medicare broker, or just interested in Medicare information to help a loved one, I recommend you download this application.

The "What's Covered" application answers a lot of questions regarding Original Medicare. You have the option of searching for any Service in the Search Bar.

After you search for an item e.g. "Hospital", the application will provide valuable information regarding if the Service is covered, how it is covered, how much out of pocket expense you could have, etc.

There is also a nice feature at the footer of the application that allows you to check on all the Preventative Services that are covered by Original Medicare.

Next time you have a question about whether Medicare covers a particular Service, you can use this great application from Medicare.

If you would like to see a Demo of the app, you can watch it here.

If you are ready to download the application on your Mobile device, you can find the links here.

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Are you paying more than the base Part B Premium of $135.50/month (in 2019)?

1/10/2019

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If so, this is most likely because your income is above the base level amounts for the Part B Premiums ($85,000 / year for single, or $170,000 /year for joint filers).

These Income Related Monthly Adjustment Amounts (IRMAAs) are intended to have higher income earners pay a higher portion of their Part B (and Part D) expenses to the government.

Here is a short video that helps explain the IRMAAs as well.

We also wanted to send out the link to the form SSA-44 that you can use to Appeal the IRMAAs if you had one of the key qualifying events (e.g. retired, windfall, etc.) in a prior year's income that was used to determine your IRMAA.

You must start the appeal process within 60 days of receiving the letter from the government about the IRMAA, so if you received the IRMAA letter in November, you're appeal window may be running out.

You can give us a call if you have any questions and/or if you would like to review your Medicare Supplement Plans to make sure you have the most cost-effective options.

Call now -
908-272-1970 (Cranford Office) or
856-866-8900 (Moorestown Office)

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Annual Enrollment Complete - $2M+ Savings for our clients!

12/10/2018

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2018 was another amazing year!

While our Annual Enrollment Period (AEP) was not flawless (it was pretty close :-), we are very pleased with the results and we hit a huge milestone of $2 Million + in savings that we were able to find for our clients on their Annual Part D Prescription Plan Review and Recommendations.

We reviewed Part D Plans for over 1,800 of our clients who responded to our reminder notifications in August & September for the Annual Enrollment Period.

We had a higher percentage of "Switch" recommendations this year. For over 50% of the Reviews, we recommended a switch due to the savings available with another Plan. In prior years, we were closer to 25% of recommendations resulting in a different plan.

At Senior Advisors, we take a lot of pride in helping our clients save money on their Medicare Plans and continue to get great coverage. We look forward to breaking $3M in Part D Savings for the Annual Enrollment Period in 2019 (Oct 15 - Dec 7).

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2019 Medicare Changes Finalized

10/13/2018

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In prior years, we didn't hear about changes to Medicare & Social Security until November/December for the following year.

However, on Friday 10/12/18, the Government Announced 2019 Changes to Social Security & Medicare which are summarized below.

2.8% increase in Social Security Payments for 2019 (biggest increase since 2012)
Minimal increase of $1.50/month in the base Part B Premium from $134/month in 2018 to $135.50/month in 2019
Minimal increase of $2 in the annual Part B deductible from $183 to $185
Minimal Increases in Part A Deductible & Coinsurance Amounts:

For the Part B Premiums, Part B Income Related Monthly Adjustments, and Part D Income Related Monthly Adjustments there were also minimal increases for 2019.

Overall, this is very good news for individuals on Social Security and Medicare. The increase in the Social Security check should far outweigh the increase in Medicare costs for 2019.

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Medicare ADVANTAGE Plans Faulted by Watchdog Over Denials of Care

9/27/2018

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With Medicare Annual Enrollment quickly approaching, a government Watchdog group found issues with Denials of Care for Medicare Advantage Plans.

If you are in a Medicare Advantage Plan or considering enrolling in one, we recommend you read the article so you are aware of the potential for Denials of Care with a Medicare Advantage Plan.

https://www.bloomberg.com/news/articles/2018-09-27/private-medicare-plans-faulted-by-watchdog-over-denials-of-care

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2019 Annual Enrollment QUickly Approaching...

9/4/2018

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In the beginning of October, we will have an opportunity to review your Prescription Drug Plan for 2019. It is very important that you take advantage of this opportunity and provide us with your latest prescriptions so we can complete the Drug Plan analysis for 2019.

There are about 25 different Part D Plans to choose from, Medicare Part D coverage changes every year, and the Prescription plans change every year. Here is a link with some details regarding the specific changes to the drug plans in 2019.

This year, we have a new online form that you can use to submit your RX information.

After you submit the RX information online, you will get an immediate email acknowledgement with an estimated processing time, which should be reduced significantly from prior years. The online form is pretty straightforward, but here is a link to a quick video which explains how to use our online form.

If your drug list hasn't changed, we still need you to complete the online form so we can ensure we have the correct drug information for the Part D Analysis.

If you are not taking any medications, please quickly fill out the online form and check the box “I am not currently taking any medications.”

The deadline to submit your form to us is November 15, but please do not wait until the last minute if you are able to submit sooner.

Our target turn-around times are below.

RX Forms submitted before October 8 - since the Part D drug plans for 2019 are not released until the first week of October, we will not be able to review your 2019 Part D Analysis until October. So, if you submit your RX information form prior to October 8, you should still receive an automatic email acknowledgement and then you will receive a Part D recommendation from us by October 17.
RX Forms submitted between October 8 and November 15- If you submit your RX information form between October 8 and November 15, you should receive a response / recommendation from us within 10-14 business days.

Do not submit your RX Forms after November 15 - we will not be able to guarantee that we will be able to review the Part D analysis and make a recommendation in time to make the December 7 deadline.

We look forward to enrolling you in the right 2019 Part D Plan for your specific situation.

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<<Previous

What would "Medicare for All" Mean for you?

Medicare will not cover these expenses

Don't Pay that Bill!

MyMedicare.gov - Another great resource

Medicare "What's Covered" App

Are you paying more than the base Part B Premium of $135.50/month (in 2019)?

Annual Enrollment Complete - $2M+ Savings for our clients!

2019 Medicare Changes Finalized

Medicare ADVANTAGE Plans Faulted by Watchdog Over Denials of Care

2019 Annual Enrollment QUickly Approaching...

Justin Lubenow

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