Annual Enrollment Period (AEP)

Salvador Dali is credited with once saying, “What is important is to spread confusion, not eliminate it.”  If you’ve been on Medicare for more than 10 minutes, you probably think that the Centers for Medicare/Medicaid Services (CMS) came up with this line.  And it’s easy to see why.  The bureaucracy and complexity of Medicare can be overwhelming.  And certain times of the year seem to highlight this feature – like the Annual Enrollment Period (AEP).

The AEP is a timeframe each fall in which you can make changes to your Medicare coverage.  We have found that there is a lot of confusion around what you can and cannot do during this period.  Hopefully the information below will help clear some things up.

What the AEP is:

• AEP begins on October 15th and ends on December 7th.
• During AEP you may enroll into or disenroll from a Prescription Drug Plan.
• During AEP you may enroll into or disenroll from a Medicare Advantage Plan.
• If you already have a Prescription Drug Plan or Medicare Advantage Plan, you may change your plan during AEP if you wish.
• Any changes you make during the AEP will be effective January 1st of the upcoming year.

What the AEP is NOT:

• AEP does not affect a Medicare Supplement (Plan F, G, etc).  If you have a Medicare Supplement, you can change your coverage anytime during the year, and you are not required to do anything during the AEP.
• AEP does not require you to make any changes to your coverage.  If you are happy with your plan, it will continue into the next year with no action required on your part.
• AEP is not the end of the world.  :-)  

Although the AEP may seem very confusing and daunting, we assure you that we can help guide you through it all.  If you have questions about your coverage or your options during this AEP, please feel free to call or email us anytime.

ObamaCare: Medicare

One question that we’ve been getting asked a lot lately is, “How is ObamaCare going to affect me?”  Well, there are many ways in which Obama will affect you (e.g. national economy, taxes, etc), but we know that you are referring to your health insurance coverage.  The answer to that question depends largely on how you obtain your health insurance; whether through Medicare, a private individual policy, or through group coverage.  We will deal with the last two situations in another article, but here we want to answer the question as it pertains to people on Medicare.

The short answer is, ObamaCare’s full implementation in 2014 will not affect you at all.  Here’s the longer answer.

When the Patient Protection and Affordable Care Act, known as the Affordable Care Act or ObamaCare, was passed in 2010, there were three major items that affected Medicare.  First, there was a provision to reduce the donut hole coverage gap on Prescription Drug Plans.  Second, there was an increase in the number of preventative services that Medicare offers.  Third, there was a reduction in payments to Medicare Advantage Plans. 

• Donut Hole.  Prescription Drug Plans provide coverage to help pay the costs of prescription drugs.  Under the old plan design, these plans assisted with prescription costs until your annual medication expenses reached a certain level ($2,830 in 2010).  At that point, you would begin to pay 100% of the cost of your medications.  The Affordable Care Act implemented a gradual phase-out of the donut hole that will be complete by 2020.  For a chart detailing this phase-out, click here.
• Preventative Services.  Medicare has always offered preventative services.  Under the Affordable Care Act, these services were expanded to include new services, as well as providing many of these services at no cost.  For a full list of the preventative services that Medicare now offers, click here.
• Medicare Advantage Plans.  The easiest way to describe a Medicare Advantage Plan is to think of it as a farming out of the administration of health benefits by Medicare to a third-party-administrator.  Private insurance companies are paid a fee by Medicare for each member they enroll to provide their health benefits.  Under the Affordable Care Act, these fees were reduced.  The effect of this has been increased premiums and reduced benefits to members of Medicare Advantage Plans.  Additionally, some plans were unable to adjust to the reduced fee schedule and canceled their contracts with Medicare thus terminating their members health benefits.

As you can see, these changes to Medicare are not insignificant.  However, they have all been in effect since 2010.  In the Medicare world, we’ve been living under the effects of ObamaCare since 2010.  Therefore if you are a Medicare recipient, there will  be no noticeable change in January 2014.  If you have further questions about this, please feel free to call or email us anytime.

Turning 65?

It’s pretty common knowledge that when you turn 65 you become eligible for Medicare.  However, it’s not always easy to figure out how you get everything in order to begin receiving benefits.  So let’s take a quick look at what that process entails.

1. Eligibility.  One of the first things you need to know is when you are eligible for Medicare.  Assuming that you are going on to Medicare due to age and not disability, your Medicare benefits will begin on the first day of your birth month.  Therefore, if you were born on June 18th, your Medicare will begin June 1st.  If you were born on the first of the month, however, your benefits will begin on the first of the preceding month.  For example, if you were born on June 1st, your Medicare benefits will begin on May 1st.
2. Part A/B?.  Medicare has two parts (Part A and Part B), and you must sign up for both if you want to receive full Medicare benefits.  In certain cases, such as coverage by an employer, you may wish to delay your Part B benefits.  If you are considering delaying your Part B coverage, be sure to obtain counsel from your employer or from an insurance professional.  If you delay your Part B benefits by mistake, it can be a very challenging error to correct; and in some cases it can mean that you will be without Part B for one year. 
   • Note:  Part A has been paid-up by your Medicare taxes over your working lifetime.  Part B, however, charges a monthly premium.  If you are, or will be, drawing Social Security retirement when your Part B benefit begins, your Part B monthly premium will be automatically withheld from your check.  If you are not drawing Social Security when you begin Part B, Social Security will bill you quarterly for this premium.  For a chart detailing the Part B premium, click here.
3. Apply.  Once you know your entitlement date and whether or not you want Part A only or both Part A and Part B, it is time to apply for benefits.  This is done through Social Security in any of three ways.
   • Online.  This can be pretty easy if you are tech-savvy.  The website is:  https://secure.ssa.gov/iCLM/rib 
   • By Phone.  You can also call and complete the process over the phone by calling:  800-772-1213, or for TTY users:  800-325-0778. 
   • In Person.  This can be the easiest way if you live near a local office.  For a list of offices click here:  https://secure.ssa.gov/ICON/main.jsp 
4. Confirmation.  After completing your application, you will receive a confirmation letter from Social Security.  Hang on to this letter as it may save your bacon should something go wrong. 
5. ID Card.  When everything has processed, you will receive your Medicare ID card in the mail.

The above, of course, is the norm.  But we all know that sometimes we find ourselves outside the norm.  If you have a unique set of circumstances and would like some advice, please feel free to call or email us anytime at 800-817-9223 or info@tweedyinsurancegroup.com.  

Scam Alert

Every so often we get emails regarding the latest Medicare-related scam circulating our the Idaho, Oregon, Washington, Utah, and Montana region.  The most recent one involves diabetic supplies.  In short, Medicare beneficiaries are getting calls from a diabetic supplier who is informing them that as of July 1, 2013, many suppliers of diabetic supplies are going out of business.  This company, however, is not going out of business and will gladly offer to be your new supplier.  Although this scam pales in comparison to many of the other ones we see, it did prompt us to write this article.  While tips to avoid every insurance scam ever imagined would fill volumes of books, we’ve boiled it down to five general rules that will get you past most any scam.

1. Make sure you know who your coverage is through.  We recommend writing the names of your insurance companies down on a piece of paper and sticking them on your refrigerator or somewhere you see often.  If you have a Medicare Supplement (e.g. Bankers Fidelity, Mutual of Omaha, or Continental Life), your Prescription Drug Plan is mostly likely with another carrier (e.g. Humana, First Health Part D, AARP United Healthcare).  If you have a Medicare Advantage Plan (e.g. True Blue, Pacific Source, Regence MedAdvantage) your health and your prescription coverage will likely be combined into one policy.
2. Don’t respond to anything.  If you receive anything (letter, post card, flyer, etc.) that looks like it’s from Medicare or your insurance company, DO NOT respond using the information provided.  Instead, call Medicare directly (800-633-4227) or your insurance carrier, depending on who the scammer is trying to impersonate. 
3. Don’t give out personal information.  If you get a phone call from Medicare or your insurance carrier, and they begin asking you personal information, hang up.  If you’re afraid that it may have been a legitimate call, simply place a call to Medicare or your carrier telling them that you received a call from them and wanted to see if there is anything they need.  Most carriers will NEVER ask for personal information over the phone.
4. Look for promises and pressure.  One common tactic of scammers is, ironically, to appeal to our fear of getting ripped off.  If there is some deal with loads of promises that sounds too good to be true, it probably is.  While there have been several changes to Medicare in the last few years, there is nothing new that is going to take away all your problems.  Also, be wary of anything or anyone that is trying to get you to act RIGHT NOW!  Any deal that is going to expire soon (like before they get off the phone) is not legitimate.
5. Use us.  If you ever get a call or receive something in the mail that sounds or looks fishy, don’t ever hesitate to drop us a call (800-817-9223) or email.  Often in just a few minutes, we can help you discern whether you’re in a situation that actually requires something from you, or whether you’re holding a 8½ x 11 inch waste of time.

The above relates specifically to insurance; below are some helpful links to avoid other types of scams. 

Idaho Attorney General

FBI Fraud Schemes

What about hearing aids?

Every so often we get questions about hearing aids.  Does Medicare cover them?  If not, will my insurance cover them?  If not, can I buy stand-alone hearing insurance?  And not surprising either, since hearing aid costs can range up to $10,000 for a set.  So what’s the scoop?

First, Medicare does not cover hearing aids.  Medicare will cover hearing and balance tests when ordered to treat you for a medical condition, but not to determine a need for hearing aids.  Since Medicare Supplements are bound by law to only fill in the gaps within Medicare (and not provide extra coverage), they are unable to pay for hearing aids.  Some people choose to receive their Medicare benefits via a Medicare Advantage Plan rather than through Original Medicare hoping to receive extra benefits.  However, most Medicare Advantage Plans in Idaho do not include hearing benefits either, and those that do typically only cover one hearing exam per year, and offer no coverage for hearing aids. 

However, all hope is not lost!  There is the option to purchase a stand-alone hearing insurance coverage.  While these policies aren’t just falling off trees, we do have one option in Idaho.  It is a combination Dental-Hearing-Vision policy and offers up to $2,000 per year in benefits.  The best part about this coverage is that it allows you to see any dentists, optometrist, or audiologist you wish, unlike many plans that restrict you to a network of providers.  This can prove to be a huge advantage in that it allows you to shop all kinds of retailers, including large discount chains like Costco where prices can be half of those found at hearing aid specialty stores.  If you would like more information about this coverage, please call or email us anytime at:  800-817-9223 or info@tweedyinsurancegroup.com.

Medicare and the Fiscal Cliff

As we ended 2012, the congressional budget talks dominated the political discussion.  The impending "Fiscal Cliff" that we were set to topple off on January 1st, 2013 was on the minds of everyone and even threatened to overshadow New Year's celebrations (say it ain't so!).  But alas, just before the stroke of midnight on December 31st, congress passed the American Tax Relief Act of 2012 and saved the day.  In an instant all our cares were over... right?  But as we awoke to the promise of a new year, the buzz was gone, and people began to wonder, what had actually been done.  Had, in fact, anything really been fixed?  And for those of us interested in all things Medicare, the bigger question was, how does this piece of legislation effect Medicare?

The short answer to the questions above is, not much.  That is, not much is fixed, and Medicare is not affected much by the law.  Not much is fixed because most of the major issues were simply pushed off until March or December of this year.  Medicare is not affected much because most of the law does not even address Medicare-related issues.  There are, however, two items that do effect Medicare recipients.

• Physician Pay Cuts.  The long-anticipated, and often delayed, 26.5% physician pay cut was delayed once again.  Congress will have to deal with this issue again before December 31st of this year, but for now doctors will not see this major drop in reimbursement. 
• Hospital Pay Cuts.  Hospitals, however, were not so lucky.  While the percentages are not nearly as high as the proposed doctor cuts, hospitals will still feel a sting.  While it remains to be seen exactly how this will effect your ability to receive care or be admitted to a hospital, it does hint that some services, like kidney dialysis, may be handed over to outpatient facilities.

On a related side note, the Social Security/Medicare tax break expired at the end of the year was not renewed.  Two years ago, active workers saw a 2% reduction in the amount of tax they paid for Social Security and Medicare.  Beginning the first of this year, that tax break will disappear.  So if you are actively employed, this may explain why your check took a little dip this month.

2013 Medicare Changes

Around this time of year we start hearing questions like, "Are there going to be any changes to Medicare this year?"  That's a great question.  And so, we'll take a quick minute and answer it for you.  The answer is yes.  Each year Medicare premiums, deductibles, and copays change.  Below we have highlighted the major changes.  These changes are universal for all Medicare recipients and thus are the same in our neighboring states as here in Idaho.

Before getting to that, however, we need to remind you that these changes may not necessarily effect your out-of-pocket expense.  If you have a Medicare Supplement, your policy is already set to adjust to pay many of these increased costs for you.  And, if you're on a Medicare Advantage plan, you probably have a totally different set of deductibles and copays to pay.

• The Part B premium increased from $99.90 to $104.90 for most people, however there are income-related increases for people with higher incomes.
• The Part A deductible increased from $1,156/benefit period to $1,184/benefit period.
• The Skilled Nursing Coinsurance increased from $144.50/day to $148/day.
• The Part B deductible increased from $140/year to $147/year.

For a full printable list of all the changes, including the income-related adjustments for the Part B and Part D premiums, click here.

Common Insurance Terms

Ha, you think!  The only thing common about insurance terminology is that they're all confusing.  We understand.  After all, insurance terminology is the second cousin to legalese!  Trying to read through a Summary of Benefits, or other health insurance material can be an exercise in frustration if you don't know the lingo.  That's why we've put together the following guide: Insurance Terminology in Plain English. 

Because we love simplicity, this isn't an all-inclusive guide of every insurance word ever used.  But, it will hit many of the most commonly used terms.  If you'd like to dig a little deeper, check out the two links below.

• A Glossary of Medicare Terms (c) Medicare Interactive
• Medicare.gov/Glossary

What The Supreme Court Ruling Means For Medicare

On June 28th, the Supreme Court ruled that the Patient Protection and Affordable Care Act (PPACA) does not violate the US Constitution.  Since then, we've been asked numerous times, "What does this mean for people on Medicare?"  Well, the answer is - surprisingly little.

When the act was passed in 2010, most of the changes that effected Medicare went into effect immediately.  The major components were:

• Many of the copays for preventative care were eliminated,
• A annual wellness visit was added, and
• The phasing out of the prescription drug "Donut Hole" began (this should be completed by 2020).

Because the Supreme Court only upheld the law, as opposed to changing it, the result was that these changes remained in place.  The bulk of what the PPACA addressed was related to insurance for those not yet on Medicare. 

Under PPACA individuals not covered by Medicare, Medicaid, or employer insurance will be required to purchase health care insurance or face a hefty "tax".  Additionally, many employers will now be required to offer health insurance to their employees.  There are exceptions, of course, to these two general statements, but they are the main thrust of the law.

What is an ABN?

These three little letters may save you a lot of money and headache.  ABN stands for Advance Beneficiary Notice.  We often get the following question, "My doctor told me that since Medicare did not cover my procedure I have to pay for it out of my pocket.  Is that true?"  The answer to that question has everything to do with an Advance Beneficiary Notice. 

There are thousands of medical procedures that Medicare covers.  There are also some that they don't.  These might include elective procedures or experimental procedures for example.  When obtaining service from a provider, it is always a good idea to ask if the service is covered by Medicare.  Your doctor or service provider is the best person to ask about what Medicare covers.  Since they depend on getting paid from Medicare, they must know what Medicare will and will not pay for.  However, at times a provider can make a mistake and provide you with a service that, once billed to Medicare, is not covered.  If this happens you are generally not liable for those charges.  There are two exceptions to this rule: 1) if it is a procedure that Medicare never covers, or 2) if you signed an Advance Beneficiary Notice (ABN). 

An ABN says, in short, that you are aware that the procedure you are getting ready to have may not be covered by Medicare but that you want to go ahead with it anyway.  This releases the provider from the liability of the charge in the event that Medicare doesn't approve the service.  However, if you don't sign an ABN and Medicare denies the claim, you are not liable for those charges.

There are some providers out there, however, who try to circumvent this problem by having you sign an ABN upon arriving at their office.  Not so fast...  Here are a few things you need to know about an ABN.

1. The ABN must describe the service.  That is, you cannot sign an all-inclusive ABN that would cover a whole list of services.  The ABN must detail precisely which service may not be covered.  
2. The ABN must include the estimated cost of the service.  Never sign an ABN that doesn't tell you how much you will be liable for if Medicare denies the claim.
3. The ABN must be provided in advance.  If a provider wants you to sign an ABN after you have already received the service, do not sign.

In short, be aware of what you are signing when a provider gives you a stack of paperwork.  If you see an ABN form, read it carefully and don't hesitate to ask questions.  One final note; an ABN only applies to persons covered under Original Medicare (Parts A & B).  If you are covered by a Medicare Advantage Plan, you generally have to pay for services that the plan doesn't approve. 

Click here to see a sample ABN form, or here to read a detailed Medicare publication regarding ABN forms.