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5 Programs that Lower Medicare Costs
Medicare Plans

5 Programs that Lower Medicare Costs

by Kimberly Johnson
written by Kimberly Johnson

5 Programs that Lower Medicare Costs

Even with Medicare, many people struggle to afford premiums, deductibles and other out-of-pockets health care costs. There are five federal programs that lower your costs for care even if you do not qualify for Medicaid: 5 Programs that Lower Medicare Costs
  1. Veterans’ Administration: If you are a vet, the Veterans’ Administration (VA) offers low-cost services and prescription drugs directly. And, you can have VA coverage as well as Medicare.
  2. Medicare Savings Programs: Depending on your income, these programs help pay for Medicare premiums and coinsurance, even if you don’t qualify for Medicaid. There are three programs, Qualified Medicare Beneficiary (QMB), Specified-Low Income Medicare Beneficiary (SLMB) and Qualified Individual (QI). Income and asset limits, and how they are counted, vary somewhat by state. You should apply through your local Medicaid office.
  3. Extra Help with Medicare Part D prescription drug coverage: You may qualify for Extra Help, which pays for some or all of the cost of your drug coverage, so long as your income is under $1471 (individual) or $1991 (couple) and your assets are below $13,070 (individual) or $26,120 (couple). You get this automatically if you have Medicaid or a Medicare Savings Program. Some states have State Pharmaceutical Assistance Programsthat provide even more assistance.
  4. Federally Qualified Health Centers (FQHCs) and other programs run by the Human Resources and Services Administration: FQHCs are located across the country and serve underserved populations and areas on a sliding-feed scale. They might waive the Medicare deductible and coinsurance, depending upon your income.
  5. Hill-Burton programs offer free or reduced care at Hill-Burton facilities in 38 states. Hill-Burton does not cover services fully covered by Medicare or Medicaid. Eligibility depends on your family size and income.

Keep in mind that you may be eligible for Medicaid based on your income after paying for some health care costs. For information on Medicaid, click here. To learn more about these programs, free local resources, and other programs that could help, contact your State Health Insurance Program. To contact your state Medicaid office, click here.

Written by Diane Archer
Huffington Post

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Medicare Plans

Moving & Medicare

by Jeff Dailey
written by Jeff Dailey

When moving to a new primary residence in another State or County, it is important to be aware that you may be required to change your Medicare Health Plan. Moving does not affect benefits for Part A (Hospitalization) and Part B (Outpatient) of Original Medicare. Nor does a change of residence affect your benefits for Medicare Supplements (often referred to as MediGap Plans). However, when moving to a different County or State there are two types of plans that can affect your benefits. If you have a Medicare Advantage Plan or Part D Prescription Plan, and that plan is not serviced in your new State or County of residence, you may need to change plans. Moving & Medicare
Part D Prescription Plans can vary from State to State and therefore may not work for you if you move to another State. If you are on a Medicare Advantage plan, you should know that Medicare Advantage plans can vary from County to County and there is the possibility that your plan may not work for you if you move to another County. Most people are aware of the Annual Enrollment Period (AEP) for Medicare Health Plans every year (currently from October 15 to December 7), however if you move to a new State or County and your plan is not serviced there, you are eligible for a Special Enrollment Period (SEP) and do not have to wait until the Annual Enrollment Period to change plans.
When changing plans during a Special Enrollment Period, you are not required to stay with the same insurance company. This is important because plan benefits and doctor networks can vary geographically, even with the same insurance company. So a company may have plans that perform better in some locations than others. Do not assume that simply because you choose to remain with the same company that your benefits will remain the same or comparable as they were on the plan at your former residence. Also, do not assume that you will access to the same size of provider network as you did at your previous home.

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Budgeting Long Term Care
Health Insurance

Budgeting Long Term Care

by Kimberly Johnson
written by Kimberly Johnson

Budgeting Long Term Care

Budgeting Long Term CareLong-term care costs are an x-factor many people simply do not think about when budgeting their retirement. The odds you’ll need some form of long-term care, however, are surprisingly high. According to longtermcare.gov, 70% of people turning 65 should expect to use some type of long-term care in their golden years. Budgeting Long Term Care
As calculated by Genworth financial, a semi-private room in a nursing home for 2015 cost an average of $80,300. When it comes to finances, seniors are generally on a fixed income, so how can a senior account for such an exorbitant cost? Well, if you plan ahead, there are a few options worth considering.

Medicaid:

While Medicaid is a great option, it’s not applicable to everyone. They have very strict financial and medical rules. Each state has individual guidelines, so check out this guide for your state’s limits and restrictions. Generally, Medicaid allows $2,199 a month in income and $2,000 in assets. The medical portion is determined by whether or not an individual needs care at the nursing home level. If you do qualify, you will not have out-of-pocket costs, but you must choose a care home that has an agreement with the state.

Qualified Income Trust:

If you do not qualify for Medicaid because your income is too high, you can open what is called a qualified income trust, income only trust, or Miller trust. Some states allow you to simply spend the extra money down towards medical care, while others make you create the Miller Trust. It depends whether your state is an income cap state or a medically needy state. Qualified income trusts allow a person to qualify for Medicaid even if their income is beyond the limit, usually around $2,000 per month. For example, if you make $2,600 a month and your state’s limit is $2,000, all money under $2,000 will go towards care, the state will keep the excess, and you will still qualify to receive Medicaid benefits.
Essentially, the creation of a qualified income trust is the state’s way of getting paid back for care and living expenses. The problem with medical spend-down or a qualified income trust is that, for the most part, all income goes towards care, leaving little behind for loved ones. If you’re not concerned with leaving a legacy, this is a great option because the cost of care will be taken care of; placing no financial burden on loved ones.

Reverse Mortgage:

Within the last few years, reverse mortgages have slowly gained in popularity. While not complex, this type of loan doesn’t work for everyone. A reverse mortgage is a loan borrowed against a house’s equity. Rather than making monthly payments, as you would with a normal mortgage, the bank reversely pays the homeowner each month. Essentially, the bank is slowly buying the house. If the borrower moves into a care home or dies, then the bank takes ownership of the home. If a homeowner is pretty healthy and wants some more money for retirement or in-home care, then this could be a decent option. If you are trying to leave your house behind for loved ones then this choice will not work. See a detailed list of pros and cons here.

Long-term Care Insurance:

If you are young and thinking ahead, one way to afford long-term care is to purchase a long-term care insurance plan while you are still healthy. A healthy 55 year old can find an affordable policy that provides adequate coverage. Once a life change occurs, such as a stroke or a fall, it becomes nearly impossible to qualify for long-term care insurance. Long-term care insurance pays for long-term care in the event that the policyholder needs it.
As mentioned above, Medicaid long-term care has a very strict qualification process, but many states offer what is called a long-term care insurance partnership. For example, if the policy covers $350,000 worth of care and that money is spent through, the policyholder can now apply for Medicaid with $350,000 worth of assets exempted during the qualification process. This is perfect for people who want to leave a legacy behind, but also need to qualify for Medicaid.
 
Max Gottlieb is the content manager of Senior Planning and ALTCS in Phoenix, Arizona. While not affiliated with any long-term care insurance provider or Reverse Mortgage brokers, Senior Planning receives many questions on these subjects. Senior Planning and ALTCS give free assistance to seniors and their families, helping them navigate the often-complicated process of finding benefits or care.
 
 

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Understanding Medicare through Supplemental Insurance
Medicare Plans

Fewer Doctors Taking Medicare Patients

by Jeff Dailey
written by Jeff Dailey

Fewer Doctors Taking Medicare Patients

 

Fewer Doctors Taking Medicare patientsIn a recent discussion with one of my doctors, he and I spent a few minutes discussing the ongoing changes and challenges facing physicians who practice medicine today, and more importantly the impact on new doctors just starting to practice. Fewer Doctors Taking Medicare patients

Many of today’s doctors leave medical school with a great deal of debt accrued during the pursuit of a medical degree, and few new graduates can afford to go into a sole private practice. A majority of recent graduates join a group or a hospital to avoid the costs of office rent, equipment purchases, liability insurance, staff costs and the monthly expenses involved in opening a new business.

Medicine used to be a patient-centered and was often a very lucrative career. But with hundreds of government regulations, and new reporting requirements increasing virtually geometrically in the past decade plus the impact of reduced reimbursements from private insurance and Medicare, it’s a whole new world of medicine.

Here’s one of the unintended consequences that has made the practice of medicine not only less enjoyable for many doctors, but will affect a number of boomers. While it might not impact everyone now turning 65 and becoming eligible for Medicare, it will add some challenges to doing so for some.

If you don’t already have a primary physician or might require a specialist, you may be surprised to learn when seeking a doctor, that a growing number won’t expand the current size of their current practice with new Medicare patients. So while you may soon be eligible for Medicare, you might struggle to find a doctor who will accept new Medicare patients.

The Kaiser Family Foundation conducted a research survey and found that 21 percent, or about one in five, physicians are not accepting new Medicare patients and 14 percent are not willing to take privately insured patients. Some physicians may or may not accept traditional Medicare patients that provide payments to those doctors based upon a fee schedule dictated by the government. Other physicians may not be willing to accept Medicare Advantage plans where paid fees are negotiated with private insurers, plans like the AARP United HealthCare, Humana and Blue Cross/Shield “Advantage” plans.

What this means to those of us that live in western North Carolina is that it might be a very good idea to make sure that your current physician, if you have one, will continue to see you when you become a Medicare patient and will accept the Medicare plan you choose. Not all doctors will accept all plans, especially certain Medicare Advantage plans.

If you’re going to become eligible for Medicare in the coming months, get in front of this potential problem. By doing that you’ll know that the doctor you have or choose will accept the plan you wish to select or help guide you in the selection of a plan that includes him or her.

Ron Kauffman is a consultant and expert speaker on issues of aging, Medicare and Obamacare. Ron is the author of Caring for a Loved One with Alzheimer’s Disease, available as a Kindle book on Amazon.com. His podcasts can be heard weekly at www.seniorlifestyles.net.

 

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Safeguard Your Identity During Holidays
Medicare Plans

Keeping Seniors Safe From Medicare Fraud

by Jeff Dailey
written by Jeff Dailey

Medicare fraudKeeping Seniors Safe From Medicare Fraud
With Medicare enrollment season coming to an end on December 7th, some seniors may be scrambling to assess plans and make final decisions. Medicare is still a very confusing topic to many seniors, and worrying about the risk of fraud can add to this frustration. During this rushed state, it’s important not to lose sight of potential issues with fraud. Keeping Seniors Safe From Medicare Fraud
Based on an Express Scripts survey, 10% of seniors said they or someone they know has been the victim of healthcare fraud. In fact, the Federal Trade Commission (FTC) has alerted seniors to several scams associated with Medicare and the Affordable Care Act.
Be careful with calls: Whether you’ve received calls requesting that you sign up for one plan in particular, calls offering you deep discounts on health services or calls from a government representative – BE WARY. If you are questioning an offer you’re receiving, reach out to the FTC or contact your current Medicare Part D plan to determine the validity of the request.
Keep track of your personal information: Never give out personal information including your social security number, bank or credit/debit card number or passwords to anyone you don’t know or haven’t specifically initiated contact with directly. This should also apply to your insurance/Medicare Part D card or ID number, which should always be kept in a secure spot. If you’re unsure, reach out to the company contacting you at a later point after you’ve had time to research their credibility.
Only look for CMS-approved plans: Before enrolling in a Medicare plan, visit www.Medicare.gov. This is the home page of the official U.S. government site for Medicare. The Centers for Medicare and Medicaid Services (CMS) require that all plans be approved. If your plan is approved by CMS, it will be listed on Medicare.gov. And don’t forget, CMS prohibits door-to-door selling of approved Medicare plans.
Toss with caution: Remove or black out personal information on prescription bottles and other health-related forms and documents before discarding. Even better…shred all personal information before discarding it in the garbage.
If you suspect you have been a victim of identity theft, or if you think you gave your personal information to someone you should not have, contact the Federal Trade Commission at www.consumer.ftc.gov.
Express Scripts has developed http://www.roadmapformedicare.com to serve as a resource for Americans looking for information on Medicare, retirement and healthy lifestyle tips. To stay up-to-date with the latest Medicare news, sign up for a free newsletter about retirement planning and Medicare at http://www.roadmapformedicare.com/sign-up/.
 

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Prescription Programs

More Americans Choosing Generic Drugs

by Jeff Dailey
written by Jeff Dailey

shutterstock_167991929 (2)More Americans Choosing Generic Drugs
Have you ever gone to fill a prescription and the pharmacist asks if you’d like the generic version of the medication, perhaps reminding you that it is at a considerable cost savings over the brand-named drug? Or you’re told that your insurance will only cover the generic equivalent of what your doctor has prescribed?More Americans Choosing Generic Drugs
The first time this happens, you undoubtedly have many questions: Is there a difference between branded and generic medicines? Will the generic be just as safe and effective? Do insurance companies prefer generics? If you have, you’re not alone in asking these questions.
-It’s no secret that the rising costs of health care services and medications have been affecting millions of Americans – indeed, our economy – and will undoubtedly continue to do so in the future. However, generic alternatives have proven to be a critical factor in slowing down national health care spending. In fact, generic drug use has saved America’s health care system approximately $1.07 trillion over the past decade, with $192.8 billion in savings achieved in 2011 alone, according to a 2012 study by the IMS Institute for Healthcare Informatics.
However, while consumers recognize the cost advantage of generic drugs, they are reminded, from time to time, of the question of quality and efficacy of generic medications versus name-brand equivalents. Consumers should know that the U.S. Food and Drug Administration, the federal agency responsible for protecting and promoting public health, requires that generic drugs must be identical or “bioequivalent” to brand name drugs in dosage form, safety, strength, route of administration, quality, performance characteristics and intended use.
“The U.S. FDA tests generic medicines just as rigorously as their branded counterparts,” explains Venkat Krishnan, senior vice president and regional director at Ranbaxy Inc. “Generic drugs must meet rigid qualifying criteria before they can be made available to the general public. At Ranbaxy, we have stringent protocols in place to ensure that our products are both safe and effective, and we stand behind that, focused on our philosophy of ‘Quality and Patients First.'”
People are choosing generics in increasing numbers, out of economic necessity and because they are increasingly better informed.Of the 4 billion prescriptions written in 2011, nearly 80 percent were dispensed using generic versions of their brand name counterpart. With generics, consumers have the option of paying a price that is as much as 85 percent lower than name-brand drugs.

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Prescription Programs

How to Manage Multiple Medications

by Jeff Dailey
written by Jeff Dailey

shutterstock_213919387Someone older than 65 takes an average of six medications a day. Taking multiple medications at the same time is called polypharmacy. But with more medications come higher costs and greater risks, so it should come as no surprise that polypharmacy is a major concern for seniors. How to Manage Multiple Medications
There are plenty of legitimate reasons why polypharmacy can occur. You may have developed a new condition, or an existing condition may have worsened. You may need certain medications to treat unavoidable side effects of other medications. And it may be that that you’re facing treatment gaps that only a combination of pills can address. It’s also possible that if you use multiple doctors, they’re unaware of what other medications you’re on, and could be prescribing medication that isn’t the best choice for you.
Fortunately, there are several things you can do to lessen both the burden and risk of multiple medications.
Step one: Take an active role in your own health. Don’t be afraid to ask questions, and do whatever it takes to understand your condition and the medications you’re prescribed. Below is a checklist of some questions you may want to ask your doctor or pharmacist.

  • Can this drug interact with any other drugs I currently take?
  • Are there any foods or drinks that I should avoid when I use this medication?
  • When and how should I take my medication?
  • What side effects can I expect to experience with this medication?
  • Is there a generic version of the drug available?
  • How long should I be on this medication? Are there any specific requirements for refilling the prescription?

Step two: Make a medication list. Make a list of the medications you’re currently taking, including prescriptions, over-the-counter medications, and vitamins or supplements. You should share this list with loved ones and every doctor you see. Include important notes about dosage/frequency, strength, what it looks like, and what condition it treats. The list should also include the name and contact information for the doctor who prescribed it, as well as how long you’ve been on the medication. If you are enrolled in Medicare Part D, you may find that your plan has online tools or a mobile application to help you keep track of this information.
You should review this list each time you see your doctor, in case there are any changes to the medications you take. This way, your doctor can identify potentially dangerous combinations, or opportunities to replace two medications with a single prescription. Your doctor may also be able to suggest switching certain prescriptions to generic versions, which can result in savings of up to 70 percent. Your pharmacist should also see this list whenever you pick up a new prescription for the first time, as a backup check to make sure it won’t be a dangerous mix.
Step Three: Minimize the number of pharmacies you use. Using multiple pharmacies increases your risk of a pharmacist missing a potentially dangerous interaction. For long-term medications, consider using a home delivery pharmacy, if available. This is a convenient and safe way to fill prescriptions, and may even save you some money.
Taking multiple medications becomes a likely reality as we age. With these simple steps, you can protect yourself, and potentially save some money. Visit Roadmapformedicare.com for more prescription drug tips and tricks, or any other questions you have about Medicare Part D. Sign up for a free newsletter about retirement planning and Medicare at http://www.roadmapformedicare.com/sign-up/.

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Health Insurance

Do you really know who is providing your medical care?

by Jeff Dailey
written by Jeff Dailey

11617.14368
Whether you’re being treated for a minor injury or undergoing major surgery, it’s likely you’ll encounter not just one, but a team of health care professionals. While having multiple professionals working to provide you with the highest quality and safest care eases some fear, it also can cause confusion. When undergoing a surgery or procedure, it is important to truly know and understand who is providing your care.
From physicians with various specialty backgrounds to nurses and assistants, it’s important to understand the credentials of those treating you. The need for more transparent communication across health and medical care providers triggered several pieces of legislation issued to protect patients.
The Truth in Healthcare Marketing Act of 2013 focuses on eliminating misleading or deceptive advertising for health care services. It also requires health care professionals to identify licenses. A congressional committee is currently reviewing the pending federal legislation.
Additionally, recent legislation in Texas requires health care providers to wear badges clearly identifying themselves in the interest of improving patient safety. For example, badges must be clearly labeled and may even be color-coded – physicians may wear green badges, while nurses may wear red badges. Similar legislation has been enacted in 12 other states.
The need to identify the differences in medical qualifications is rooted in the quality and effectiveness of health care. A recent American Medical Association survey revealed 90 percent of respondents said a physician’s additional years of medical education and training, when compared to a nurse, are vital to optimal patient care. Furthermore, 83 percent said they prefer a physician to have primary responsibility for the diagnosis and management of their medical care.
It’s important for patients to know who is involved in providing their care, including the education, training, degree, licensure and clinical experience of each person. Without this essential knowledge, a patient is not well positioned to make the most informed and best decisions for their care.
For example, there are several levels of anesthesia providers – an Anesthesia Care Team consists of a physician anesthesiologist, nurse anesthetists and anesthesiologist assistants. To ensure the most optimal care, a physician anesthesiologist should always oversee other members of the Anesthesia Care Team, according to the American Society of Anesthesiologists.
Physician anesthesiologists have 10,000 to 14,000 hours of specialized medical education and training, while nurse anesthetists have 1,000 to 2,500 hours. In addition, physician anesthesiologists are able to diagnose and respond to any medical complications that may arise suddenly due to their exhaustive education and training.
In an emergency, when seconds count, having a physician anesthesiologist advocate for you or your loved one can make the difference between life and death. “I was caring for a 23-year-old first-time mother,” says Patrick H. Allaire, M.D., a physician anesthesiologist practicing at a 220-bed hospital in Ames, Iowa. “I had just given her an epidural and was still on the ward when her nurse ran into the hall calling for help. I ran back to her side and immediately determined she was having a heart attack.
“Fortunately, I was able to diagnose the multiple complications occurring and treated each quickly,” says Dr. Allaire. “We performed a cesarean section and delivered the baby safely. It remains to this day one of my biggest saves – two lives at once. I am absolutely certain that had I not been immediately present, this story would have a very different and heart-wrenching ending.”
Dr. Allaire recounts several instances where he bumped into his patients at the grocery store or ice cream shop over the years following this life-saving event. Each time, the mother reminded her daughter who Dr. Allaire was, affectionately referring to him as their “guardian angel.”
As a patient, it’s essential to be informed. Knowing who is on your medical team, their respective roles and what training and education they bring to the table ensures you are well prepared to achieve the most optimal outcomes. As a patient, you must feel empowered to ask questions about your providers’ qualifications and experience. Being inquisitive isn’t intrusive; after all, every patient deserves the highest quality and safest medical care.

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Health Insurance

5 Things to Consider When Comparing Health Insurance Plans

by Kimberly Johnson
written by Kimberly Johnson

shutterstock_157876310Whether you’re in good health naturally or you rely on medication and specialists to stay that way, finding the right health insurance plan is key—and you could pay a penalty if you don’t have it. 5 Things to Consider When Comparing Health Insurance Plans
If you’re self-employed, your employer doesn’t offer health insurance, or even if you simply think you might be better off on a different plan than what your employer offers, you may find yourself buying individual health insurance. While shopping for your own health insurance may seem daunting, breaking down the plans can help you make a more informed decision.
“People need to be careful when comparing plans,” says Joel Cantor, director of the Center for State Health Policy at Rutgers University. “People tend to make the mistake of looking at the premium only and not cost-sharing. It’s a little more of a complicated calculation.”
Some individual plans may leave more money in your pocket than others, even though at first blush they may not look that way.
For example, if your employer does not offer health care coverage, you may qualify for tax credits and other subsidies in an individual plan, making your costs lower. Though less likely, you may be at an age and state of health where you can buy an individual plan that is less expensive than the one your employer offers.
If you are employed you are likely paying only 15 to 20 percent of the premium, says Paul Fronstin, director, health research and education program at Employee Benefit Research Institute in Washington, D.C.
“Premiums in the non-group [individual] market are age rated, and the younger you are, the lower the cost. But it still might be more than your work,” Fronstin says.
For those with health concerns, some individual plans may also offer more value than others, or even more than an employer-offered plan. These may allow you to find the right network, specialists, and prescription coverage for your needs.
Bear in mind, however, that you have to be on your toes when it comes to finding a healthcare plan that will really offer valuable savings, because plans and their costs change frequently.
The Kaiser Family Foundation, a health policy nonprofit, released an analysis in June 2015, projecting changes to premiums in the individual marketplace in 2016. The report found the most popular individual plans are increasing on average 4.4 percent from 2015 to 2016, which they said is moderate but a bigger jump in price from the previous year. The report stresses the value in shopping at each open enrollment period, as premiums fluctuate.
Open enrollment for 2016 begins Nov. 1, 2015 and extends to Jan. 31, 2016. It’s always worth considering all options, especially where your health and budget are concerned. Here are some things to consider when evaluating the pros and cons.

  1. Your medical needs: Make a list of any doctors, specialists, prescriptions, or other services you require to maintain your health or to prevent health issues.
  2. Your budget: Figure out how your budget will allow you to spend on health insurance and health care each month.
  3. Premiums + network + cost sharing: Check the premiums, network, and cost-sharing specifics of each plan. Cost sharing includes deductibles, co-pays, and coinsurance. Compare not only the premiums, but also whether all your anticipated medical costs are covered in-network or if you will have to pay for out-of-network to see your preferred doctors. Evaluate all of these costs to determine if there is a better savings (monetary) or value (more affordable access to your required specialists and prescriptions) in one plan vs. the other.
  4. State vs. federal coverage: Keep in mind that in most states, individual coverage is federally managed, while in a handful of others, it’s managed at the state level or some kind of hybrid between the two. If applicable, evaluate any benefits in your state’s coverage. For example, some coverage that may vary includes birth control, breastfeeding, dental and vision.
  5. Tax credits and other savings qualifications: Determine whether you qualify for tax credits and other savings offered in the state marketplace. This will be an important factor in determining whether an individual plan makes more sense for you, cost-wise. According to Healthcare.gov, your employer can tell you if its plan meets the standards of the Affordable Care Act, thereby disqualifying you from any savings on the individual plan.

Beth Shea Palmer is a reporter and editor based in Chicago.
Written by Equifax Reporter on September 17, 2015 in Insurance

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