About to Turn 65? Which Way Do You Want Your Medicare Coverage?
By BOB MOOS/Southwest public affairs officer for the Centers for Medicare and Medicaid Services
Every day, another 10,000 baby boomers turn 65. Most know they’ll be qualifying for Medicare, but many don’t realize they’ll have two ways to get their new health care coverage.
So here’s a brief primer for all those busy boomers who are fast approaching Medicare age but haven’t had time yet to focus on the decisions they’ll soon be making about their health care.
One decision will be whether to join the traditional fee-for-service program run by the federal government or sign up for a Medicare Advantage health plan sold by a private insurer. About three in four beneficiaries opt for Original Medicare, which has existed since the 1960s. With this kind of coverage, you can go to any doctor, hospital or other provider that accepts Medicare patients.
Medicare pays the doctor or hospital a fee for the service you receive. That fee generally covers 80 percent of the Medicare-approved amount for the care, after you meet your annual deductible.
You have a few choices for covering the other 20 percent:
You may use your retiree health plan from your former employer, if you have such a policy. Some employers assume at least part of the cost, so retiree plans may be less expensive or more generous than other supplemental coverage.
You may qualify for Medicaid, if you have limited income and savings. Besides helping you with your out-of-pocket costs like co-insurance and deductibles, the state-and-federal Medicaid program may pay for your monthly Medicare premiums, too.
If neither of those two options applies, you may buy a “Medigap” policy from a private insurer to cover deductibles and co-insurance costs. There are 10 kinds of Medigap plans, with different benefits, so you’ll have to decide which best fits your needs.
Though Original Medicare’s Parts A and B cover most of your hospital and doctor bills, you’ll also want to think about adding the Medicare drug benefit by enrolling in a Part D plan from a private insurer. Even if you don’t take a lot of prescriptions, it’s still smart to consider the coverage when you first become eligible for Medicare. Otherwise, you may have to pay a late enrollment penalty later.
Original Medicare remains the favorite among people who want the broadest possible access to medical providers. When coupled with a supplemental plan, it makes health care costs relatively predictable. Still, one in four beneficiaries now prefers to receive care through a private health plan. Instead of choosing Medicare’s traditional fee-for-service program, you can buy a Medicare Advantage plan.
With Medicare Advantage, insurance companies contract with the government to provide care. The private insurers set their own premiums, deductibles and co-payments for their clients. The health plans may offer cost advantages over Original Medicare and some added benefits, but, depending on the particular plan, they may also restrict your choice of hospitals and doctors. Many Medicare Advantage plans charge a premium on top of your Part B monthly premium, but, unlike with Original Medicare, there’s no need for you to buy supplemental “Medigap” insurance.
As for drug coverage, you’ll generally need to get it through your Advantage plan. Most plans, in fact, include prescription drugs with their other benefits and charge a single premium. Medicare Advantage enrollment has grown by 10 percent in 2012 and exceeds 13 million nationwide, or 27 percent of Medicare beneficiaries. In Louisiana, it has increased 10 percent and totals 179,696, or 25 percent of beneficiaries. The private health plans have been especially popular among people with low to moderate incomes. They provide relatively affordable supplemental coverage, with lower premiums that those for Medigap policies.
So what’s the better choice: Original Medicare or Medicare Advantage? There’s no single correct answer. It depends on your individual circumstances and preferences. A good way to familiarize yourself with your options is to visit www.medicare.gov and browse through the “Medicare and You” handbook. It provides an excellent overview of the Medicare program. Becoming informed will help you choose the health care option that’s best for you. It’ll also help you avoid mistakes that may cost you money.
July 2, 2012
Children's Health Grants Available
There's thousands of dollars in grant funding available now to families with children who have medical conditions.
The UnitedHealthcare Children's Foundation is seeking grant applications from families in need of financial assistance to help pay for their child's health care.
Qualifying families can receive up to $5,000 each year with a $10,000 lifetime cap to help pay for medical services such as physical, occupational and speech therapies, counseling services, surgeries, or prescriptions; and equipment such as wheelchairs, eyeglasses or hearing aids, according to foundation.
There's no deadline for when families need to apply.
Dr. Penny F. Walker, senior medical director for the southeast region of United Healthcare clinical services, said members of the foundation, which started in 2007, felt there was a need to enhance the clinical condition and quality of life for children with medical conditions for which treatments were not covered or only partially covered by insurance.
Healthcare Law Benefits Louisiana Residents With Medicare
By BOB MOOS/Southwest Public Affairs Officer for the Centers for Medicare & Medicaid Services
We hear a lot of back and forth these days about the Affordable Care Act – the federal healthcare law – but not much about how it affects people with Medicare.
When you sort through all the rhetoric, one thing is clear: The two-year-old law contains some real benefits for those who get their health insurance through Medicare.
Take the “doughnut hole” in Medicare’s prescription drug program.
During the first few years of the drug benefit, many seniors had to bear the full cost of their prescriptions once they reached this gap in coverage. It was a burden for most.
But under the Affordable Care Act, seniors who fall into the hole are getting bigger and bigger price breaks on their drugs each year. By 2020, the gap will disappear.
This year, for instance, you get a 50 percent discount on your brand-name drugs and a 14 percent discount on your generics while you’re in the doughnut hole.
Those savings have added up to $46 million for almost 75,000 Louisiana residents with Medicare over the last year. That’s an average savings of $618 per person.
The Affordable Care Act also helps people with Medicare by eliminating out-of-pocket costs for many preventive services that detect problems early, when they’re most treatable.
Medicare now offers a long list of free screenings, such as for cancer, cardiovascular disease, diabetes and osteoporosis, as well as free shots for the flu and pneumonia.
There are also new screenings and counseling for alcohol abuse, depression and obesity.
The healthcare law creates another important benefit for people with Medicare -- a free annual wellness visit with your doctor to keep you healthy.
The check-up includes routine measurements like your blood pressure, a review of your prescriptions and medical history, and an assessment of any risks to your health.
The annual visits follow the “Welcome to Medicare” exam you can get during the first year you sign up for Medicare’s Part B outpatient coverage.
More than 487,000 Louisiana residents with Medicare received free preventive services – such as colonoscopies and mammograms – or a free wellness visit last year.
Because of new financial incentives the Affordable Care Act provides insurers, seniors also can expect to see better quality in their private Medicare Advantage health plans.
For several years, Medicare’s website – medicare.gov -- has posted quality ratings for Medicare Advantage plans to help beneficiaries make informed choices.
Now, to further motivate insurers to improve their performance, Medicare will pay bonuses to plans with higher quality scores. Medicare also will let seniors switch to the top-performing plans year-round instead of during just the fall open enrollment period.
The healthcare law also strengthens consumer protections. No longer can Advantage plans charge you more for some services (like chemotherapy) than if you were in traditional Medicare.
To make sure the patient comes first, the government also will require the health plans to restrict the share of premiums they can use for their administrative expenses and profits.
Finally, the Affordable Care Act helps stop Medicare fraud with tougher screening procedures for health care providers, stronger penalties for crooks and new technology for crime-fighters.
The government is now using sophisticated computer software to identify patterns of fraud and target criminals. The same kind of software has helped credit card companies go after con artists.
The anti-fraud efforts recovered $4.1 billion last year – money that can be returned to the Medicare trust fund to extend its life and make the program stronger.
All told, the average person with Medicare will save $4,200 over the next decade because of the two-year-old health care law. That’s welcome news for anyone on a limited budget who struggles with the chronic illnesses that come with age.
March 2, 2012
Medicare Part B Deadline Approaching
If you didn’t sign up for Medicare Part B medical insurance when you first became eligible for Medicare, you now have an opportunity to apply — but time is running out. The deadline for applying during the general enrollment period is March 31. If you miss the deadline, you may have to wait until 2013 to apply.
Medicare Part B covers some medical expenses not covered by Medicare Part A (hospital insurance), such as doctors’ fees, outpatient hospital visits, and other medical supplies and services.
When you first become eligible for hospital insurance (Part A), you have a seven-month period in which to sign up for medical insurance (Part B). After that, you may have to pay a higher premium — unless you were covered through your current employer's group health plan or a group health plan based on a spouse's current employment. You are given another opportunity to enroll in Part B during the general enrollment period, from January 1 to March 31 of each year. But each 12-month period that you are eligible for Medicare Part B and do not sign up, the amount of your monthly premium increases by 10 percent.
There are special situations in which you can apply for Medicare Part B outside the general enrollment period. For example, you should contact Social Security about applying for Medicare if:
• you are a disabled widow or widower between age 50 and age 65, but have not applied for disability benefits because you are already getting another kind of Social Security benefit;
• you worked long enough in a government job where Medicare taxes were paid and you meet the requirements of the Social Security disability program and became disabled before age 65;
• you, your spouse, or your dependent child has permanent kidney failure;
• you had Medicare medical insurance (Part B) in the past but dropped the coverage; or
• you turned down Medicare medical insurance (Part B) when you became entitled to hospital insurance (Part A).
You can learn more about Medicare by reading our electronic booklet, Medicare. Or visit the Medicare website. You may also call Medicare at 1-800-MEDICARE (1-800-633-4227; TTY 1-877-486-2048).
Thank you for visiting www.LSMS.org. The LSMS hopes to better serve Louisiana's citizens by providing the latest medical news and health information to patients and their physicians. The informational links below are intended to serve as a starting point and are for reference only. Only a physician or other appropriate health care provider can properly diagnose and treat health conditions. Remember, your personal physician is your best health care advocate!