All posts by David Higgs

Proposed Changes to Medicare Payments

CMS, who manages Medicare, has recently announced some proposed changes to how Medicare reimbursements will be made.  These proposals are targeting such areas as:  Hospital Observations status, Physicians, Skilled Nursing Facilities, Part B drugs, etc.  The various proposals are accepting comments in June.  The main goal of the proposed changes is to reward better patient health and cost efficiency.

You can check back on this blog for updates once these proposed changes have been finalized or go to CMS.gov.

Based in the Richmond, Va area, David Higgs of Choices In Medicare specializes in helping seniors transition to Medicare.  He can be reached at email address:  David@ChoicesInMedicare.com or go to website:  www.ChoicesInMedicare.com

Medicare Patients are the Customers!

I am always reminding my clients, especially my Part C Medicare Advantage clients, that they are the Customer.  They can and should ask how and where they can lower their medical costs.  If a doctor prescribes a test, they should ask why it is needed and more importantly, where can they get that test done that will cost them the least based upon the specific Plan they have.  Most of us are not accustomed to asking our doctors these types of questions.  We think “they are the doctor, they should know best.”  In many cases they don’t have any idea of the variances in costs for certain medical tests.  Costs vary widely based upon where a test is administered and which Plan a patient has.

This is less of an issue for my Medicare Supplement clients; however, this concept of asking, also applies to prescriptions.  As almost everyone has a Prescription plan (whether it is a stand-alone Part D drug plan or it is embedded in a Medicare Advantage Plan), there are many variables to lowering drug costs.  Here too, ask for lower cost alternatives such as Generics and shop around at different pharmacies.  A recent article describing proof that both doctors and patients are missing opportunities to lower costs is linked below:

http://khn.org/news/by-not-discussing-cost-issues-doctors-patients-may-miss-chances-to-lower-out-of-pocket-expenses/

The bottom line is Medicare Beneficiaries should get in the habit of asking questions regarding how, where and when they can save money when something is prescribed.  I do it and I recommend my Medicare clients do it.

Based in the Richmond, Va area, David Higgs of Choices In Medicare specializes in helping seniors transition to Medicare.  He can be reached at email:  David@ChoicesInMedicare.com or go to website:  www.ChoicesInMedicare.com

CMS Finalizes 2017 Medicare Advantage Payment

CMS has just released their 2017 Medicare Advantage plan capitation rate.  On average, the payment will increase by .85%.  You may recall that Medicare Advantage plans, also known as Medicare Part C, are one way Medicare Beneficiaries can get their Medicare.  This shifts the risk and responsibility for a Beneficiary’s Medicare claims from Medicare to the private insurance company offering the Medicare Advantage plan.

This slight increase probably means most plans will not have to change their benefits much.  We will know in October when all 2017 plans will be published.  The increases fluctuate from year to year.  If you want to know more about this news story, click on the link below.

http://www.bloomberg.com/news/articles/2016-04-04/u-s-increases-2017-medicare-advantage-rates-less-than-expected

If you have questions about Medicare coverages or the difference between Medicare Advantage plans and Medicare Supplements, contact me at:  David@ChoicesInMedicare.com or go to www.ChoicesInMedicare.com website.

Medicare Beneficiaries’ Cognitive Health Tied to Heart Health

Here is another reason Medicare Beneficiaries should strive for improved Heat Health:  improved cognitive health.  A recent study released in the Journal of the American Heart Association found that the more heart-healthy steps people attain, the quicker and sharper their thinking skills.  So, not only will efforts to improve heart health help you live longer, but will help your memory and thinking skills.

To see more of the article, click on the following link:  http://consumer.healthday.com/cardiovascular-health-information-20/heart-attack-management-and-prevention-news-365/a-healthy-heart-may-protect-an-aging-brain-709040.html

If you have questions about Medicare, contact David Higgs at David@ChoicesInMedicare.com or go to www.ChoicesInMedicare.com

Medicare Telehealth Bill

Earlier this month, a bipartisan bill was introduced in both the Senate and Congress to allow Telehealth services to be covered by Medicare.  The Medicare Telehealth bill would allow seniors to “see” a doctor from the convenience of their home via computer or smart phone device.  This could be extremely beneficial for seniors who are less mobile but have minor illnesses and just need a prescription.  Telehealth has been growing over the last few years and now could be extended to cover seniors.  It would be a “win-win” solution as it would save Medicare billions of dollars and provide conveniences to Medicare beneficiaries.  Stay tuned over next few months for progress on this bill.

To read more about this bill, click on the following link to the article:  http://www.bna.com/lawmakers-introduce-medicare-n57982066990/

We here at Choices In Medicare help people transition into Medicare.  If you have questions or need assistance obtaining Medicare Supplemental coverages, contact us at:  David@ChoicesInMedicare.com or go to our website at:  www.ChoicesInMedicare.com

Private Exchanges and Choices In Medicare

Many Retirees and other Medicare eligible beneficiaries will be directed to a Private Exchange to select their health plan benefits.  Typically, large employers and some large Benefits firms are getting into the Private Exchange arena.  The latest entrant is the financial services firm, Fidelity, who has announced this as a strategy.  A Private Exchange is similar to the Affordable Care Act Marketplace Exchange which was designed for people under 65.    An Exchange is merely a website that lists a person’s options and allows enrollment.  By itself, an Exchange is OK but there are some things anyone contemplating their options via an Exchange should be aware of.  I have reviewed some of the Exchanges and found a few common issues:

  1. The Exchange is going to be limited to a few plans from a few carriers. This means that there may be other options which could be lower cost that won’t be available.
  2. The people staffing the inbound phone lines are sometimes not experienced, independent Benefits professionals. Their knowledge can be limited to the training received for that call center role.
  3. Some of the information on the Exchange is either out dated and/or inaccurate.
  4. In many cases where the beneficiary is an employee, the employer contribution will only apply if the employee obtains their benefits through the Exchange. This could mean an employee must limit themselves to the Exchange options even though there may be better options available.
  5. The Exchange experience is not very personable. You are dealing with someone you don’t know in an unknown location.

So what is the alternative?  People like me usually allow you to avoid these pitfalls.  As an independent agent, I represent most or all of certain types of available plans.  For example, I represent all of the Medicare Advantage plans in Central Virginia and 7 of the largest, national Medicare Supplement companies.  In most cases, I can meet face-to-face and establish a better environment when making such important decisions and, at no cost to the client.

If you have questions about your Choices In Medicare, contact me at David@ChoicesInMedicare.com or visit our website:  www.ChoicesInMedicare.com

Medicare Eligible Women and Atrial Fibrillation Danger

A recent study concludes that atrial fibrillation (a-fib) affects women more significantly than men.   A-fib is a common heart rythm problem but women are twice as likely to suffer a stroke and a high percentage will die from heart attack compared to men.  This affects all women, both young and older, Medicare eligible women.  Women should take a-fib seriously and have it monitored.

For more info on this topic, see article linked here:  http://consumer.healthday.com/women-s-health-information-34/misc-women-s-problem-news-707/common-irregular-heart-beat-may-pose-bigger-threat-to-women-than-men-707195.html

For more info on how Medicare policies address these kinds of conditions, contact me at David@ChoicesInMedicare.com or go to www.ChoicesInMedicare.com website.

Happy New Year! – New Medicare #’s to Know in 2016

It is New Year’s Day in 2016 and that means new Medicare numbers to know for this year.  In most years, CMS, who manages Medicare, increases some of the costs associated with Medicare Part A, Part B and Part D coverages.  The following shows some of the key numbers that have increased for 2016.

  • Part A deductible – Will be $1288 from $1260 (per 60 day Benefit Stay)
  • Part B Deductible – Will be $166 from $147 (Annual deductible)
  • Part B Premium – Will be $121.80 from $104.90 (Will not apply to existing 2015 beneficiaries who have it taken out of Social Security)
  • Part D Maximum Deductible – Will be $360 from $320 (Some plans don’t have a deductible)
  • Part D Premium National Average – Will be $34.10 from $33.13 (Is used to determine Part D Penalty)

While none of these are dramatic, it is still important to be aware of the changes.  Also, even with these increases, Medicare coverage and any applicable Supplemental coverages you may have is great coverage.

You can read more about this topic at Medicare.gov website by clicking on the following link:  https://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2015-Press-releases-items/2015-11-10.html

If you have questions about your Choices in Medicare, please contact me at David@ChoicesInMedicare.com or go to www.ChoicesInMedicare.com

CMS Announces 2016 Changes to Medicare Part B Premium/Deductible

I reported this past July that CMS (who manages Medicare) announced there were possible, significant increases coming to Medicare recipients for their Part B premium and deductible.  This past Wednesday, Nov 11th, they announced that they have finalized the amounts of the increases.

The good news is they significantly scaled back the amounts of the increases.  2016 Part B premiums will increase from $104.90 to $121.80 for many people.  It will include those that newly enroll in Part B, those that don’t currently collect Social Security and higher income recipients primarily.  This increase will not affect approximately 70% of recipients that are currently on Part B and have the premium deducted from their Social Security check.

Part B deductibles will increase from current $147 to $166.  After several years of no increases, this will be much more tolerable than the initial amount proposed.

To read more about it, you can go to the CMS website linked here:  https://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2015-Press-releases-items/2015-11-10.html

If you have any questions about Medicare insurance coverages, feel free to email David@ChoicesInMedicare.com or go to www.ChoicesInMedicare.com.

2016 Medicare AEP Opens Oct. 15th Through Dec. 7th

It’s that time of year again for Medicare beneficiaries.  The 2016 AEP, or Annual Election Period, is the one time per year when Medicare beneficiaries can change their Medicare Advantage Plan or Part D drug plan without needing a special election period.  People who have a Medicare Supplement policy do not have to do anything with their policy unless they want to change their prescription plan.  The AEP begins Oct. 15th and runs through Dec. 7th.

Keep in mind this is also the only time the insurance companies can make changes to their plans.  If they do, they will send the member an Annual Notice of Change (ANOC) describing the changes for the upcoming year to be effective on January 1st.

If beneficiaries have questions or want to make changes, they should contact their insurance carrier or agent.

Or, they can contact David Higgs of Choices In Medicare at David@ChoicesInMedicare.com with questions.