Your New Medicare Card is Coming

New Medicare CardYou read about identity theft every day and we are deluged with information about various ways to protect ourselves. Nevertheless, those of us over 65 carry a Medicare card in our wallet or purse that, in most cases, displays our Social Security Number (SSN). Despite all the concern about protecting that sensitive SSN, the government has insisted on using that number for Medicare for many years. That is about to change!

The Medicare Access and CHIP Reauthorization Act of 2015, or MACRA, contained a provision requiring the Centers for Medicare and Medicaid Services (CMS) to remove SSN’s from Medicare cards. Beginning in April, CMS will begin sending out new cards to Medicare recipients with an ID number that is randomly generated and bears no resemblance to your SSN. The cards won’t go out all at once but some will be mailed out each month until the process is finished in April 2019.

According to the CMS Press Release last month, “The goal of the initiative to remove Social Security numbers from Medicare cards is to help prevent fraud, combat identify theft, and safeguard taxpayer dollars,” said CMS Administrator Seema Verma. “We’re very excited to share the new design.”

After testing 10 different designs, CMS ended up staying with the familiar red, white and blue theme as shown in the photo above. The new cards will go out to about 58 Million people with instructions to securely destroy their old card once the new one is received. Even with the new card, Medicare recipients are advised to keep their Medicare Claim Number confidential to avoid claims fraud and abuse.

Some Seniors Refusing Needed Care at Home

According to a recent article from Kaiser Health News, some seniors are refusing important medical care at home. Sometimes this is because of pride in independent living but sometimes it is because they are confused about what “home health care” is and whether or not insurance covers it.

Home Health Care is not the same as Home Care but, unfortunately, the terms are often used interchangeably and that is confusing. Home Health Care means your doctor has prescribed home health care involving intermittent skilled nursing care, physical therapy, speech-language pathology or continued occupational therapy. These services are paid by Medicare although you may be responsible for a portion of the bill for some equipment like wheelchairs, walkers, and oxygen equipment.

Home Care, on the other hand, generally refers to 24-hour a day care at home, meals delivered to your home and homemaker services like laundry, shopping, and cleaning. Home Care also includes help with Activities of Daily Living (ADL) such as bathing, dressing and using the bathroom when this is the only care you need. These Home Care services are normally not covered by Medicare, and unfortunately, this is where confusion can occur.

To understand what Home Health Care is and how Medicare defines it, be sure to download this free publication from the Center for Medicare/Medicaid Services (CMS).

When Home Health Care is advised after a hospital stay, some seniors refuse the care mistakenly thinking that it is not covered by Medicare and they are concerned that they cannot afford to pay out of pocket. In these cases, important follow-up treatment is not received and medical complications can result.

If you get your medical services through a Medicare Health Plan (such as a Medicare Advantage Plan), be sure to check your Summary of Benefits to see how Home Health Care is covered under that plan as it may be different than how Traditional Medicare covers it.

If you or someone you know is offered Home Health Care, be sure to discuss the options in detail with your doctor. Make sure you understand what is covered by Medicare and what is not. It is important that critical follow-up care is received to make sure that complete recovery occurs.

 

Seniors and Mental Illness

Older man in cafeThe month of May is Mental Health Month so it is very appropriate that we talk about mental illness as it relates to seniors. The National Council on Aging (NCOA) reports that one in four older Americans will experience some form of mental illness so this is not some rare occurrence we are talking about. Contrary to some negative stereotypes, it is not a normal part of aging to feel lonelier or more unhappy as people get older.

In an article published on May 4, the NCOA discussed the two major areas of concern: anxiety and depression. No one should have to suffer under the assumption that nothing can be done or that help is not available. If you or someone you know exhibits symptoms of anxiety or depression, it is important to seek help immediately.

There are many symptoms and diagnoses for anxiety. It is important not to “self-diagnose” any illness, but some symptoms to be on the alert for are panic attacks, nightmares, phobias or chronic worry about everyday activities. The nonprofit organization Mental Health America (MHA) has developed a free, anonymous online screening tool for anxiety. To be clear, this is not the same as a medical diagnosis, but some may find it helpful to use the screening results to start a conversation with their own physician.

Depression can also take many forms. You may notice in yourself or others symptoms such as poor sleep, extended periods of sadness, loss of enjoyment in everyday activities or loss of energy. Many articles have been written about depression creating a greater risk for suicide, but depression can also lead to an overall lower quality of life and even to physical health problems. Here again, MHA has developed an online screening tool for depression that people may find helpful in determining to seek professional help.

For people over 65, Medicare helps cover a wide range of mental health services including tests and visits with a physician, psychiatrist or social worker. Part D coverage can also help cover the costs of many medications prescribed to treat mental illness.

Although the month of May is designated as a time for heightened awareness of mental illness in our country, we should always be on the alert for symptoms in ourselves and in those we love. The stigma of the words “mental illness” have often caused people to avoid even discussing the issue. Just as with any other health issue, you should never hesitate to discuss your concerns with your family or you personal physician.

 

Beware of “Observational Care” in Medicare

Many people on Medicare are getting surprised by big bills after what they thought was an in-patient hospital stay. What they are discovering is a situation known as Observational Care. This is a weird occurrence that is happening due to certain Medicare rules.

Under Medicare, in order for your doctor to admit you to the hospital, he or she must verify that your condition requires at least two days (known as the “two midnights” rule) in the hospital. If the doctor is not certain but feels you are too sick to go home, then you may still stay at the hospital under “observational care”. In this case you are considered too sick to go home but not sick enough to be admitted to the hospital. Yes, it sounds odd and it is.

In this circumstance, you may not only be observed, buy may also receive short-term treatment and tests. The key, with regard to Medicare, is that since you are not an inpatient, the costs are considered outpatient care which is paid at a different rate under Part B of Medicare instead of Part A. Depending on your Supplement or Medicare Advantage plan, you may be looking at significantly higher copays and coinsurance than you would if it were actually a hospital stay.

In addition, any days spent in Observational Care do not count toward the three days (three-midnight rule) hospitalization necessary to make a stay in a Skilled Nursing Facility eligible for Medicare coverage. That can be a huge surprise if you end up having to pay out of pocket for a few days recuperating in such a facility.

Because many people were unaware of the difference between being an in-patient and observational status, the US Congress did take some action. Now a person must be notified within 36 hours of being under observational care that this is their status and what the ramifications of that status might be.

As always, you are your own best advocate. If you find yourself headed to the hospital under your doctor’s direction, make sure you know whether it is as an in-patient or for observational purposes. The difference can be expensive!

 

Seniors and Traveling Abroad

Now that you’ve ditched that 9-5 job, you’ve pulled out the Bucket List and found foreign destinations on the agenda. Excellent! In addition to checking Expedia and those cruise line brochures. the US Department of State’s Bureau of Consular Affairs has a few tips for you. On their website they have an article appropriately titled “Considerations for Older Travelers“.

While I recommend taking the time to read the entire publication, here are some highlights to remember.

  • Travel Documents: Make sure they are all correct and up to date. Make sure your passport will be valid for 6 months beyond the end of your trip or some countries may not let you enter.
  • Sign up for the State Departments “Smart Traveler Enrollment Program” where your itinerary and contact information is stored securely. This allows the embassy or consulate to contact you in case of an emergency or a security situation.
  • The State Department reminds you that Medicare does not cover you out of the US and recommends that you obtain travel insurance. You can start on that project by visiting our Travel Insurance page right here on this website.
  • Medications: Be sure to take an adequate supply of your prescriptions and leave them in the original, labeled container to avoid problems at customs. Also, know the generic name for your drugs as the generic may be more likely known in a foreign country.
  • Financial: Be sure to know the currency of the countries you are visiting and whether you should convert prior to entering the country. Also, make sure your credit cards will be accepted where you are traveling. Finally, check the State Department’s “Country Information” page to learn about any ATM scams or other financial scams that might target US visitors.

You’ve probably spent years saving and planning for these trips so it only makes sense to be prepared. Do a little homework and plan on having the time of your life!

Changing Medigap Plans? Be Careful!

Shopping for Medigap PlansSo you have had your Medigap (Medicare Supplement) Plan for several years, the price has gone up and you’re thinking of switching. No problem there, but keep a few things in mind to avoid shooting yourself in the foot.

First, recognize that almost all plans have rate increases. It is important to compare your plan to others to see if the increase is reasonable. If you feel it is not, then go ahead and shop around. I suggest using an agent that specializes in Medicare products but you can certainly do it on your own.

Make sure you are comparing similar plans. This is easy with Medigap Plans because the federal government began requiring companies to standardize their plans many years ago. If you have a Plan F, then a Plan F from another company will be the same in all major respects. It doesn’t hurt to check a company’s AM Best rating just to see how it compares to others. Certainly, you want a financially sound company backing up your plan.

Most importantly, remember that Medigap Plans are medically underwritten if you are not in your Open Enrollment Period or in a Guaranteed Issue situation. This means that the company can take a look at your current health situation and legally decline to offer you coverage. Most applications have “key” questions that clearly state that a “Yes” answer disqualifies you for coverage. But even if you answer none of those questions positively, you may still be declined.

Even if your application seems to be perfect, never — and I repeat here NEVER — discontinue your current Medigap Plan until you have the new policy and ID cards in your hands. I say this even if it means that you pay two premiums in the same month while you wait for approval. The reason should be obvious. If you cancel your current plan, then two weeks later receive a declination from the new company, you have NO Medigap Plan.

So, shop wisely, purchase carefully and if you need help call me at (208) 263-2194 or fill out the Contact Form.

Introducing Idaho Senior Insurance

Medicare Insurance Products

I am pleased to be able to launch my new website, Facebook page, and Twitter feed for Idaho Senior Insurance products for Medicare beneficiaries. While the introduction of these new media sites marks a significant change in my insurance practice, it is important to note first what is not changing:

  • I still work for North Idaho Insurance, an office of Alliant Insurance Services, Inc.
  • North Idaho Insurance still offers a full spectrum of insurance products for Business, Commercial, Auto and Home needs. In fact, our agency just moved into more modern and spacious offices at 509 N 5th Ave Ste H, in Sandpoint and added another experienced agent to handle the growth of the agency.

So, what is changing?

  • I am now concentrating my personal practice on Senior Insurance products such as Medicare Supplements, Advantage and Drug plans, Final Expense plans and Dental and Vision plans.
  • I will continue to service all of our agency’s individual and group health and life clients as well.
  • By focusing on just one area of insurance, a pleasant side effect is that I will usually be able to work less than 5 days per week.

Over the years many of my clients have found the area of Senior Insurance products to be confusing and intimidating. Unfortunately I was unable to devote the time necessary to expand this part of the agency as long as I was also committed full-time to our Commercial and Personal Lines products as well.

Now, by concentrating solely on this area, I have been able to take on the additional companies and products needed to offer my clients the widest choice of plans and pricing available. In addition to companies I have long represented such as Blue Cross, Regence, Bridgespan and Delta, I have now taken on Senior Insurance industry leaders like Humana, Aetna, Security Life, PacificSource and Transamerica, among others.

So if you are a Senior (like me!) and need to review your coverage, or you happen to be approaching that landmark Medicare age of 65, be sure to phone me for an appointment at (208) 263-2194 or submit the Contact Form.

For over 30 years I have enjoyed helping people find solutions to their insurance needs and I look forward to continuing that process with this new area of specialization.

Medigap or Medicare Advantage – Which is Best?

Which is best, Advantage or Medigap?Folks on Medicare find out quickly that, as nice as it is to have Medicare, the program simply does not pay for everything. Most everyone faces a choice of selecting a private plan to make up some of the difference. The most common choices are either a Medicare Advantage Plan that includes Drugs, or a Medigap Plan combined with a separate Drug Plan. I often get the question, “Which is best?” As with so many such questions, the correct answer is that “It depends.”

The Medigap plans are more accurately called Medicare Supplement Plans and they come in several different options standardized by the federal government into “lettered” plans (Plan C, Plan F, etc). These plans have been around a long time and although each plan varies, they can pay some or all of your Part A (Inpatient) Deductible, Part B (Outpatient) Deductible, the other 20% of the Medicare approved amount for certain services, the balance left over when doctors charge in excess of the allowed amount, some coverage for out of the country needs and so forth. What is common about them is that they can be used with any doctor that accepts Medicare. So, no networks, no referrals, no having to choose a Primary Care Provider. Medigap Plans do not cover drugs so it is necessary to purchase a separate Part D Drug Plan (PDP) to cover that aspect of your health care.

Medicare Advantage Plans have been around in one form or another since the 1970’s. Rather than filling in the “gap” in what Medicare doesn’t pay, they actually replace Medicare for your coverage. They typically don’t have deductibles for inpatient or outpatient care but it is common for them to have co-pays for doctor visits, a certain number of days in the hospital and so on. Many are HMOs and some are PPOs, but what they generally have in common is a preferred network of doctors and providers. If you go out of network you either pay more or, in some cases, have no coverage at all. The exception is that emergency and urgent care is almost always covered at in-network pricing regardless of where you are when the incident happens. Medicare Advantage Plans generally have the option of including Drug coverage in the plan. Medicare Advantage Plans, by and large, cost less than a Medigap Plan combined with a separate Drug Plan.

People who travel a lot, perhaps spend months in Arizona or elsewhere, may find Medigap or Supplement Plans to be a better fit, despite the higher cost, because there are no network restrictions. For people who get their primary care near their home and might only need emergency care when occasionally traveling, may find a Medicare Advantage Plan more to their liking, but it is important to examine the network and make sure it works for you.

Finally, since Medigap plans tend to leave you with less to pay out of pocket for doctor visits and hospital stays, I also usually recommend that you carefully consider your own health history before purchasing either type of plan. If you visit the doctor often or have just a couple of hospital stays, the savings of the Medicare Advantage lower premiums can quickly disappear in multiple copays.

As with all such decisions, I recommend that you sit down with an insurance agent that specializes in this sort of coverage, or do some very careful research on your own. To set up an appointment with me, just phone or return the Contact Form. To research on your own, the best place to start is the official government website, Medicare.gov.