When you first enroll in Medicare Part B, Medicare provides an initial "Welcome to "Medicare" visit. This initial "Welcome to "Medicare" visit is different than the Annual "Wellness" visits that Medicare provides. There is some confusion about these two types of visits, so we have provided some highlights of what is included with each of these visits below.
"Welcome to medicare" visit
Per the Medicare website, "This visit includes a review of your medical and social history related to your health and education and counseling about preventive services, including these:
The "Welcome to Medicare" visit must be completed within 12 months of your Medicare Part B effective date. There is no cost to the Medicare Beneficiary for the "Welcome to Medicare" visit, unless the doctor identifies/diagnoses any additional conditions, tests, etc.
Annual "Wellness" Visit
AAfter the first 12 months on Medicare Part B, the Medicare Beneficiary is entitled to an Annual "Wellness" visit.
Per the Medicare website:
"The cognitive impairment assessment is performed to look for signs of Alzheimer's disease or dementia and check for depression and other mood disorders. Your provider may order other tests, if necessary, depending on your general health and medical history.
The personalized prevention plan is designed to help prevent disease and disability based on your current health and risk factors. Your provider will ask you to fill out a questionnaire, called a “Health Risk Assessment,” as part of this visit. Answering these questions can help you and your provider develop a personalized prevention plan to help you stay healthy and get the most out of your visit. It can also include:
We hope this provides some clarity about the differences between the "Welcome to Medicare" versus the Annual "Wellness" Visits. It is also important that Provider billing offices understand these differences. We have had some issues with Provider billing offices attempting to bill the Annual "Wellness" visit codes to Medicare when someone was still in their first 12 months of Medicare. This results in declined claims because the Annual Wellness visit is only available once per year starting 12 months after the Part B effective date.
For several years, the Medicare Advisory Group of NAHU has been working on fixing the delayed effective date that occurs for certain Medicare Beneficiaries who enroll during their last three months of their Initial Enrollment Period, or during the General Election Period (January 1 – March 31).
We are excited that our proposed fixes were finally implemented in the Consolidated Appropriations Act of 2021. The changes begin on line 21 of Page 2168 of the bill.
The new rules will begin on January 1, 2023.
Initial Enrollment Period: The Current Rules require a delay of 2-3 months for the Part B effective date when someone enrolls in the three months following their 65th birthday. The New Rules will remove that delay and provide the Part B effective date of the first of the month following enrollment. The table below summarizes the Current rules versus the New rules for the Initial Enrollment Period.
The table below provides an Example for someone who is turning 65 on September 15.
General Election Period: The General Election Period of January 1 through March 31 is for a Beneficiary who missed their Initial Enrollment Period and does not have credible coverage. These individuals must enroll during the General Election Period of January 1 through March 31, and the effective date is July 1. With the New Rules coming in January 2023, the Beneficiary will get an effective date of the first of the month following enrollment. The table below summarizes the Current rules versus the New rules for the General Election Period.
The table below provides an Example for someone who is enrolling during the General Election Period.
We are excited that we have had such a positive impact on Medicare Beneficiaries enrolling during these two time periods and reduced their delays in getting their Medicare Part B coverage!
We will continue to work in Washington to address our other key initiatives: Medicare COBRA Trap, Observation Status, and more.
According to Social Security, about 21% of married couples, and 45% of unmarried persons rely on Social Security for 90% of their income. This is clearly concerning since Social Security was only intended to provide about a third of your retirement income needs (other two thirds was supposed to be individual savings, and pensions).
For a lot of retirees, this limited income combined with debt can result in some Credit issues. If you happen to have credit issues, there are numerous providers out there that claim to be able to help repair your credit. It can be difficult to filter through the different options, understand the different services & costs involved. There are also numerous Credit Repair Scams to avoid!
Money.com recently published a good article that outlines the 6 best credit repair companies with costs and benefits of each service. The article also does a good job explaining Credit Repair Scams.
We are excited to launch our new web-series, called "Coffee with Justin" which is launching in the next couple of weeks.
Justin will be meeting with guest speakers, from a variety of different backgrounds: Employees of Senior Advisors, Clients of Senior Advisors, Financial Advisors, Insurance Brokers, Doctors, Legislators, and more.
These will be short-videos (~15-25 min) in which Justin has a chat and coffee with the Guest Speaker. We look forward to a day we can do these videos in person, but for now they will be Virtual meetings /recordings.
You can watch the short video below to learn more. If are interested in being one of our Guest speakers on the show, please contact us and let us know.
We work closely with several Financial Planning firms to assist their clients with their Medicare Planning needs.
A few days ago, one of my colleagues, Bob Ruelle, a Financial Advisor from Bleakley Financial (Fairfield NJ) sent me a recent article that was published online in Investment News, titled "Medicare questions spike as boomers work past 65".
I quickly reviewed the article and it was pretty comprehensive, but I did notice a pretty glaring error for people enrolling in COBRA after age 65. I have written extensively on this topic in the past... see Cobra Trap Article and Home Depot wins court case.
I emailed the editor to explain the error. She was very gracious and appreciative and she updated the article with my COBRA comments.
You can find the link to the updated article here.
In February 2021, I had the opportunity to interview Congressman Joe Courtney from Connecticut to discuss a key Medicare issue we have been working on for several years, related to "Observation" status in the hospital.
When you are in the hospital in an "Observation" status (before getting "Admitted"),
(1) your medication costs are still covered under your Part D prescription plan rather than your Part A hospital benefits. If you are administered expensive drugs, this could result in high out-of-pocket costs for the patient;
(2) if you need Skilled Nursing Care after the hospitalization, the Medicare Part A benefits will not cover the costs. You will be required to pay out of pocket for the Skilled Nursing Care.
In the video, Congressman Courtney and I discuss these issues and some legislation that is being worked on to fix these problems for the Medicare Beneficiary.
Thank you for watching.
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Each year during the Open Enrollment Period (October 15 - December 7), Medicare Beneficiaries have an opportunity to review their Part D Plans for the following year. For most Beneficiaries, this is the only time throughout the year that they can change their Part D Drug Coverage for the following year.
The Part D Plans change every year, so even if your drug list doesn't change we highly recommend reviewing the Part D Plans each year to make sure you have the right Part D Drug Plan for the following year.
We send out reminders to all of our clients in September/October each year to get their latest Rx information to rerun the Part D analysis for the following year.
In 2019, we started tracking the savings that our Part D Recommendations make for our clients and we were able to save them over $2 Million for their 2020 Part D Plans.
In 2020 (like 2019), our recommendations were able to save our clients over $2 Million for their 2021 Part D Plans.
We look forward to continuing to help our clients get the most robust and cost effective coverage for their Medicare Plans!
Every year during this time, we help Medicare Beneficiaries review their Part D Drug Plans to ensure they have the most cost-effective Part D coverage for the following year.
We save about $2 Million per year for our clients by just finding the most cost-effective Part D Drug Plans. You can read more about our Part D review process here.
In reviewing thousands of client's drug lists each year, we also uncover some of the seemingly unscrupulous Pricing Strategies of Pharmaceutical companies.
A few years ago, we wrote an article about a specific dosage of Metformin (1000mg XR) which costs 1,000 times more than if you just take two pills of the 500mg XR. That's right, the retail cost was about $7,000 per month versus about $7/month for the 500mg of the same exact medication.
This year, I would like to highlight another very common issue we see with Pharmaceutical pricing: Drug Manufacturers taking two less expensive pills, blending them into one pill and charging a huge markup on the price of the medication.
The example I saw today was for "Pioglitazone/Metformin 15mg/850mg". I was reviewing a Part D analysis for one of our clients and noticed that the only Part D Plans that covered this medication were the higher premium Part D Plans (about $75/month vs about $10-$15/month that most people pay for Part D Premiums). With some further digging on GoodRx.com, I found that the retail cost for this blended medication is about $260/month.
This got me thinking... how much would it cost to take the Pioglitazone and Metformin separately. It turns out the retail cost for Metformin is about $16/month and Pioglitazone is about $150/month. So, if we simply add up the cost of these two pills, one might think it should cost about $166/month retail cost for the combined medication. Or perhaps, a slight markup for the convenience of taking one pill instead of two pills.
But no... there is a 57% markup to get the combined pill of Pioglitazone/Metformin 15mg/850mg which has a retail cost of ~$260/month.
Let that sink in.
What other industry can we add such little value (take 1 pill instead of 2 pills) and justify a 57% price markup? This is one of the key reasons the Diabetic Medicine industry is approaching $100 Billion per year.
So, when I hear about Pharmaceutical companies justifying their pricing strategies to account for R&D expenses to "innovate" and create new life-saving treatments, it makes me question if these types of R&D discussions include innovations like blending two pills into one.
CMS just announced the updated Part B premiums for 2021.
This is good news as it is a relatively low increase (less than 3%) for both the Part B Premium and Part B Deductible.
The Income Related Monthly Adjustment Amounts (IRMAAs) were also updated for 2021. You can find the tables below for individuals with income greater than $88,000 (or joint filers with income less than $176,000). This income is based on your MAGI (Modified Adjusted Gross Income) from your 2019 Tax Return.
If you are in one of the higher income brackets for the Part B IRMAAs, there is an additional IRMAA for the Part D Drug Coverage. The updated table for 2021 can be found below.
Over the last few weeks we have been very busy with the Annual Part D Drug Plan reviews. We have received overall 1,000 requests for reviews and a majority have already been processed all within our target turnaround timeframes.
For the 2021 Part D recommendations we have completed thus far, the projected 2021 Part D savings is more than $1,000,000!
Top 6 Plans so far for 2021
We run the analysis to identify the most-cost effective Part D Plan using the Medicare Plan Finder. You can watch a quick video using this link, if you are interested in how we identify the most cost-effective plan.
There are about 30 Part D plans to choose from in each state. From our reviews, the top 6 plans thus far (table above) make up about 80% of the recommendations thus far.
Open Issue with Cigna & Express Scripts - will be resolved on Monday, Oct 26, 2020
For those of you that currently have a Cigna or Express Scripts Part D Plan, there is an issue with the data file that these carriers provided to CMS on October 15. This data issue is preventing us from reviewing your Part D Plans until the data issue is resolved. We are in close contact with CMS, and we are told this data issue should be resolved on October 26. If this is fixed correctly, we will be able to get to your Review & Recommendations by the first week of November.
If you haven't already sent in your 2021 Part D Review request, you can click this link to submit your 2021 information for a 2021 Part D Review. Our deadline to receive the information is November 15 to provide enough time to complete the reviews, recommendations, and enrollments by the government deadline of December 7.
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