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Medicare Policy Non-Renewal Notices Can Be Confusing and End in Cancellation

Due to the confusing nature of letters and notifications from insurers about changes to Medicare, often, Medicare Advantage beneficiaries end up not renewing their contracts. Moreover, what happens if a Medicare Advantage plan was not renewed by the insurer and the beneficiary did not understand that?

While this situation can be confusing, the beneficiary does have a special enrollment period available to make changes to their Medicare coverage. Most years, that special enrollment lasts until February 28. If the beneficiary opts to remain in the Original Medicare, they would typically enroll in a Medicare Part D drug plan and a Medigap plan. Most insurers advise Medicare beneficiaries when they discontinue coverage that the insured has a “guaranteed issue right” for Medigap plans.

The beneficiary would also be well advised to consider a Medicare Part D drug plan to handle the cost of prescription drugs. There are numerous Part D options that can be compared by using the Find Health and Drug Plan tool at www.medicare.gov. In the alternative it is always easy to call 1-800-MEDICARE to get assistance in comparing costs and coverage options.

What if the beneficiary wants to choose another Medicare Advantage plan? It is a good idea to figure out precisely how the plan is to be used before making any calls or doing research. Some Medicare Advantage plans have hearing, vision and dental services, services that a beneficiary may not need. Or they may wish to choose a plan that offers all three. Again, beneficiaries have the option of going online to see what kinds of Medicare Advantage plans are available for 2019 and use Find Health and Drug Plan tool at www.medicare.gov.

It is worth noting that Medicare Advantage plans usually have a contracted network of hospitals and physicians and also have out-of-pocket expenses that the beneficiary is responsible to pay. It is worth asking for a summary of benefits for any chosen option in order to compare various alternatives.

Medicare is changing but it is not clear yet how. That leaves beneficiaries struggling to make the best available choices open to them at the time they come up for enrolment or when they first become eligible for Medicare. The one thing to know with certainty is that whatever is purchased now is likely to be portable later and that in buying the best option(s) now is likely to mean cost savings in the long run. Always know that if you are having trouble figuring out what your best Medicare options are, you can always call a knowledgeable insurance agent who can help you make an informed choice.

Posted on Tuesday, April 2nd, 2019. Filed under Medicare.

New Political Landscape May Result in Medicare Negotiating Drug Prices

Given the uncertain political climate, any new proposed legislation may or may not come to pass. Just recently a bill was introduced that could let Medicare negotiate lower drug prices.

House Democratic members and one Republican indicate that if it can be passed, the bill would provide more power to the Health and Human Services (HHS) secretary to regulate Part D of Medicare. Part D covers drugs America’s seniors get. While some politicians seem to favor this kind of a move Big Pharma vigorously opposes it as do many Republicans. Right now, private insurers and pharmacy benefits managers do the drug price negotiating.

The rationale behind negotiating prescription drug prices for the over 43 million Medicare Part D beneficiaries is because it is one of the best methods to lower medication costs and open the door wider for seniors to get the medications they need at reasonable prices. The idea of letting another body negotiate drug prices is not new. There is a similar program run by the Department of Veterans’ Affairs. According to a House Committee on Oversight and Government Reform report if the government negotiated drug prices, it would potentially cut government spending by $156 billion over a ten-year period.

Another analysis of drug pricing in the U.S., compiled by Rx Savings Solutions, found that over 36 drug manufacturers raised drug prices on hundreds of medications by an average of 6.3 percent.

Trump tweeted his frustrations about drug hikes this weekend, saying that companies “were not living up to their commitments” on pricing. The comments followed an analysis by Rx Savings Solutions that found more than three dozen drugmakers raised the prices on hundreds of medicines in the U.S., for an average increase of 6.3 percent. The Pharmaceutical Research and Manufacturers of America (PhRMA), says the analysis “flawed and inaccurate.”

There are a number of other suggestions on the table on how to reduce the price of drugs, such as letting Medicare Part B negotiate prices, moving to approve a larger number of less expensive generic drugs and having drug companies post their drug prices in commercials aired on T.V.

Posted on Wednesday, February 27th, 2019. Filed under Medicare.

Medicare PACE a New Program for U.S. Seniors Needing Medical Care

Good news for seniors who wish to stay in their home and community instead of going to a senior care facility. A new program offered by Medicare — Medicare PACE — will allow seniors to receive health care from the comfort of their homes and communities. This program is not available in all states.

Medicare PACE stands for Program of All-Inclusive Care for the Elderly. Currently roughly 40,000 seniors participate in Medicare PACE and receive in-home care. The program is optional but is turning out to be a really good support for elderly Americans in need of social services and more inclusive, personal, in-depth medical care.

The Medicare PACE program is designed to allow seniors to continue to live at home and in their communities instead of senior facilities. Seniors may qualify be eligible for the PACE program if they are in need of nursing home-level care, are able to live safely in the community, are 55 or older and are living in a PACE service area.

Those participating in the program have a medical team dedicated to them and their health care needs. Each team features a primary care doctor, occupational therapist, recreational therapist, nurse, social worker, physical therapist, activity coordinator, home care liaison, dietician and various other medical professionals.

With a team working with you, you get personalized, one-to-one care. You may need use a PACE-preferred doctor, but that is to your advantage as the physicians are trained in a multi-disciplinary approach to senior care. There is no deductible/co-payment for medications, services or care approved by your health care team. It is covered under the program for eligible beneficiaries.

What does PACE cover? Currently, it covers a wide variety of services that may change over time or be added to as it grows. The services covered include:

  • Physical therapy
  • Occupational/recreational therapy
  • Laboratory
  • X-ray services
  • Home/Hospital care
  • Emergency services
  • Meals
  • Medical specialty services
  • Nursing home care
  • Adult day primary care
  • Mental health services
  • Dentistry
  • Prescription drugs (partially covered under program)

 
It is important to note that you may choose to get your medications through the PACE program and can still enroll in Medicare Part D. However, if you do enroll in a prescription drug plan, you are disenrolled from PACE.

What do you pay for PACE? If you have or qualify for Medicaid, you do not pay the premium for long-term care. However, if you do not qualify for Medicaid but have Medicare, you do pay the monthly premium and a premium for prescription drug coverage.

Posted on Friday, November 30th, 2018. Filed under Medicare.
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