|Posted on November 14, 2018 at 9:35 PM||comments (4)|
The Annual Enrollment Period (AEP) for 2018 will start on Oct. 15, and will run through Dec. 7. Your clients who are Medicare beneficiaries can take this opportunity to make coverage changes, which they may want to do if their health care needs have changed during the year. It's also a good time to check whether your clients' Part D plan has announced changes to prices or its formulary effective in 2019 to determine whether a change to another plan is warranted.
Many beneficiaries hold misconceptions around Medicare. In particular, they don't realize that Medicare is not a "one and done" decision. They should review their coverage annually. The best time to do this is during the AEP. View the AEP as an opportunity for your clients to be proactive in their Medicare planning.
What clients may not realize about the AEP
Beneficiaries also often misunderstand the purpose of the AEP and what they can and cannot do regarding their Medicare coverage. Because of the media attention the AEP receives while it is ongoing, beneficiaries recognize the term but do not always have a clear idea of its purpose.
You may want to remind your clients of what the AEP means:
What the AEP is not: The AEP has nothing to do with enrolling (or disenrolling) in Medicare Part A or Part B, or making changes to Medicare Supplement (Medigap) plan coverage.
What the AEP is: The AEP provides beneficiaries with an opportunity to make changes to their Medicare Advantage (MA) and Part D coverage. Changes made are effective on Jan. 1 of the following year.
What can be done during the AEP: During the AEP beneficiaries may make the following changes to their Medicare coverage:
Medicare changes AEP
* "Creditable" coverage means the alternative prescription drug plan is at least as good as or better than Medicare Part D, as determined by an actuarial study. The plan sponsor should be able to provide that information to you.
Be sure to have clients review their Part D coverage
Of the changes allowed during the AEP, the opportunity to change Part D prescription drug plan coverage is probably the one that affects the most Medicare beneficiaries. It provides beneficiaries with an opportunity to change coverage in the event of changes to their own prescription drug regimen or their current drug plan's formulary or costs (premium, copays, coinsurance).
Even if beneficiaries do nothing else during the AEP, they should check to determine whether their current Part D plan makes sense going into the new year. Many beneficiaries end up paying hundreds or even thousands of dollars more for their medication due to ignoring this annual exercise.
|Posted on August 14, 2018 at 11:50 PM||comments (0)|
A growing majority of Americans agree: Health care shouldn’t be a business. They’re finally coming around to the idea that it can and should be a public good instead — something we can all turn to when the need arises.
The favorite right-wing argument against Medicare for All — the most popular approach to universal, publicly financed heath care — is that it’s too expensive. More on those costs in a moment. But first, we should note that our current health care system is actually the most expensive in the world by a long shot, even though we have millions of uninsured and underinsured people and lackluster health outcomes.
This is partly because a lot of that money doesn’t go directly toward keeping people healthy. Instead it goes to the overhead costs required to keep businesses running. These include exorbitant executive salaries, marketing to beat out the competition, the labor-intensive work of assessing and denying claims and so on. None of these would be a factor in a single-payer, Medicare for All system. Taiwan and Canada both have single-payer systems, and both spend less than 2 percent of total expenditures on administrative costs — and so does the United States’s current Medicare program. By contrast, private insurers in the United States spend as much as 25 percent on overheads.
But the most important way Medicare for All would save money isn’t by slashing administrative costs. It’s by using the power and size of the government, like other countries around the world currently do, to negotiate favorable terms with drug companies and service providers. There’s a reason a CT scan costs $896 in the United States, but only $97 in Canada.
And what about the sticker shock factor — the dramatic rise in government spending to accommodate such a program? Medicare for All would transfer all payment responsibility to one public agency (as opposed to a bunch of private companies), and that act of combination produces the big price tag that conservatives use as a cudgel. But while this would be more expensive for the government, it wouldn’t be for ordinary Americans. The money would be raised through progressive income and corporate taxes and end up costing most people less than their current health care. And coverage would be comprehensive and universal, meaning nobody would ever be unable to afford the care they need.
Pursuing Medicare for All would come with its own set of dilemmas: Eliminating an entire industry won’t be easy, and we’ll face plenty of political resistance and calls for half-measures. But if we want actual universal coverage, and we want it to be affordable and high-quality, Medicare for All is the only way forward.
By Meagan Day and Bhaskar Sunkara
Ms. Day is a staff writer at Jacobin, where Mr. Sunkara is editor.
The New York Times
August 10, 2018
|Posted on July 24, 2018 at 4:50 PM||comments (0)|
Should you pay $268 more for your Medicare Advantage? If Washington doesn’t stop the Health Insurance Tax, every senior on Medicare Advantage could pay $268 more every year. That’s $161 billion on the backs of seniors over the next 10 years.
Act NOW. Use the link below to complete the form to tell your member of Congress to protect your Medicare Advantage.
|Posted on July 12, 2018 at 4:30 PM||comments (0)|
By Virgil Dickson | July 2, 2018
Medicare Advantage enrollees spend less time in nursing facilities after surgery and are less likely to be readmitted to the hospital when compared with those in traditional Medicare, according to a new report.
MA enrollees on average spent five fewer days in skilled nursing facilities and received 463 fewer minutes of rehabilitation therapy for hip fractures, according to a report in the June 2018 edition of PLOS Medicine, a peer-reviewed journal.
MA patients also were less likely to be readmitted to hospitals, less likely to become a long-term resident at a nursing home and were more likely to stay in their communities after release from rehab compared to fee-for-service Medicare patients.
"The results suggest that for hip fracture patients who are otherwise healthy, longer lengths of stay in skilled nursing facilities may not translate to better outcomes," Vincent Mor, the study's co-author and a professor of health services, policy and practice at Brown University, said in a statement.
The results come as the number of seniors in MA plans continues to rise and as the CMS seeks to cut spending on skilled-nursing homes by creating a new value-based care model.
Medicare spending for skilled-nursing facility services in fiscal 2002 was $14.5 billion, about 5.6% of total Medicare spending. By 2016, that budget was $29.1 billion or about 8% of Medicare spending, according to the Medicare Payment Advisory Commission.
|Posted on June 20, 2018 at 5:20 PM||comments (0)|
Why is the Coalition Working to Protect Seniors in Medicare Advantage?
While beneficiaries report overwhelmingly high-levels of satisfaction with their Medicare Advantage plans, challenges for the program lie ahead. Medicare Advantage provides quality health care services at an affordable price to nearly 20 million beneficiaries nationwide. Medicare Advantage means more to beneficiaries then just leading a healthy life. It gives them security and peace of mind. We need to protect it.
The Coalition for Medicare Choices is dedicated to protecting Medicare Advantage by actively communicating with members of Congress about issues that affect coverage. Coalition members have participated in rallies, dozens of town hall meetings involving members of Congress, made thousands of phone calls to congressional offices and written more than 350,000 letters to their members of Congress. Join us!
|Posted on January 23, 2018 at 5:05 PM||comments (0)|
A Medicare Special Election Period (SEP) allows you to enroll in Medicare or change your Medicare coverage outside of your Initial Enrollment Period or other enrollment periods without penalty. There are different SEPs to cover different circumstance. A Qualifying Life Event (QLE) means a change in your situation — like getting married, having a baby, or losing health coverage — that can make you eligible for a Special Enrollment Period, allowing you to enroll in health insurance outside the yearly Open Enrollment Period. The special enrollment period generally lasts 60 days before or after the qualifying life event.
If you qualify for Medicare, but you have health insurance through an employer's group health plan, you may be able to delay enrollment in Medicare Part B. When your employer-based coverage ends, you may be eligible for a Special Enrollment Period (SEP) to enroll in Medicare Part B without facing a late-enrollment penalty. Such a penalty is permanent so enrolling on time is crucial!
Here’s a full list of all life events that qualify for a special enrollment period, organized by those four categories.
Loss of health insurance
Losing job-based coverage
Losing COBRA coverage
Losing individual health coverage for a plan or policy you bought yourself
Losing eligibility for Medicaid or Children’s Health Insurance Program (CHIP)
Losing eligibility for Medicare
Losing coverage through a family member
Changes in household
Having a baby, adopting a child, or placing a child for foster care
Getting divorced or legally separated and losing health insurance
Death of someone on your individual health insurance policy
Changes in residence
Moving to a new home in a new zip code or county
Moving to the United States from a foreign country or U.S. territory
Moving to or from the place you attend school, if you’re a student
Moving to or from the place you both live and work, if you’re a seasonal worker
Moving to or from a shelter or other transitional housing
Other qualifying changes
Changes that make you no longer eligible for Medicaid or CHIP
Gaining membership in a federally recognized tribe or status as an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder
Becoming newly eligible for Marketplace coverage because you became a U.S. citizen
AmeriCorps VISTA members starting or ending their service
Find out today if you qualify for SEP!