January is Cervical Health Awareness Month. Cervical cancer is preventable with vaccination and appropriate screening, so it is important that we raise awareness of the preventive care that supports cervical health. The CDC lists two tests to help prevent cervical cancer or to find it early: Pap smears and HPV tests. A Pap Smear looks for cell changes on the cervix that might become cervical cancer if not treated, while the HPV test looks for the virus that can cause these cell changes. Medicare Part B covers these tests if you meet the eligibility requirements. Schedule your preventive visit today and take charge of your cervical health!
Dear Marci
I have been enrolled in the same Part D plan for years. Today I learned that it’s no longer covering a prescription I have been taking. Am I eligible for a transition fill while I figure out what to do next?
-Ralph (Nallen, WV)
Dear Ralph,
A transition refill, also known as a transition fill, is typically a one-time, 30-day supply of a drug that you were taking:
Before switching to a different Part D plan (either stand-alone or through a Medicare Advantage Plan)
Or, before your current plan changed its coverage at the start of a new calendar year
Transition refills are not for new prescriptions, though. You can only get transition fills for drugs you were already taking before switching plans or before your existing plan changed its coverage.
The following situations describe when you can get a transition refill if you do not live in a nursing home (there are different rules for transition refills for those living in nursing homes):
1. Your current plan is changing how it covers a Medicare-covered drug you have been taking. If your plan is taking your drug off its formulary or adding a coverage restriction for the next calendar year for reasons other than safety, the plan must either:
Help you switch to a similar drug that is on your plan’s formulary before January 1
Or, help you file an exception request before January 1
Or, give you a 30-day transition fill within the first 90 days of the new calendar year along with a notice about the new coverage policy.
2. Your new plan does not cover a Medicare-covered drug you have been taking.
If a drug you have been taking is not on your new plan’s formulary, this plan must give you a 30-day transition refill within the first 90 days of your enrollment. It must also give you a notice explaining that your transition refill is temporary and informing you of your appeal rights.
If a drug you have been taking is on your new plan’s formulary but with a coverage restriction, this plan must give you a 30-day transition refill free from any restriction within the first 90 days of your enrollment. It must also give you a notice explaining that your transition refill is temporary and informing you of your appeal rights.
In both of the above cases, if a drug you have been taking is not on your new plan’s formulary, be sure to see whether there is a similar drug that is covered by your plan (check with your doctor about possible alternatives) and, if not, to file an exception request. (If your request is denied, you have the right to appeal.)
Remember: All stand-alone Part D plans and Medicare Advantage Plans that offer drug coverage must provide transition fills. When you use your transition fill, your plan must send you a written notice within three business days. The notice will tell you that the supply was temporary and that you should either change to a covered drug or file an exception request with the plan.
I hope this helps you determine if you are eligible for a transition fill at this time! Best of luck.
-Marci
-Ralph (Nallen, WV)
Dear Ralph,
A transition refill, also known as a transition fill, is typically a one-time, 30-day supply of a drug that you were taking:
Before switching to a different Part D plan (either stand-alone or through a Medicare Advantage Plan)
Or, before your current plan changed its coverage at the start of a new calendar year
Transition refills are not for new prescriptions, though. You can only get transition fills for drugs you were already taking before switching plans or before your existing plan changed its coverage.
The following situations describe when you can get a transition refill if you do not live in a nursing home (there are different rules for transition refills for those living in nursing homes):
1. Your current plan is changing how it covers a Medicare-covered drug you have been taking. If your plan is taking your drug off its formulary or adding a coverage restriction for the next calendar year for reasons other than safety, the plan must either:
Help you switch to a similar drug that is on your plan’s formulary before January 1
Or, help you file an exception request before January 1
Or, give you a 30-day transition fill within the first 90 days of the new calendar year along with a notice about the new coverage policy.
2. Your new plan does not cover a Medicare-covered drug you have been taking.
If a drug you have been taking is not on your new plan’s formulary, this plan must give you a 30-day transition refill within the first 90 days of your enrollment. It must also give you a notice explaining that your transition refill is temporary and informing you of your appeal rights.
If a drug you have been taking is on your new plan’s formulary but with a coverage restriction, this plan must give you a 30-day transition refill free from any restriction within the first 90 days of your enrollment. It must also give you a notice explaining that your transition refill is temporary and informing you of your appeal rights.
In both of the above cases, if a drug you have been taking is not on your new plan’s formulary, be sure to see whether there is a similar drug that is covered by your plan (check with your doctor about possible alternatives) and, if not, to file an exception request. (If your request is denied, you have the right to appeal.)
Remember: All stand-alone Part D plans and Medicare Advantage Plans that offer drug coverage must provide transition fills. When you use your transition fill, your plan must send you a written notice within three business days. The notice will tell you that the supply was temporary and that you should either change to a covered drug or file an exception request with the plan.
I hope this helps you determine if you are eligible for a transition fill at this time! Best of luck.
-Marci
Health Tip!
For many people, the start of the new year is a time to reflect on what we’ve learned and set new goals as we look ahead. You might evaluate your physical and mental health and think of the changes you want to see in the coming year. Making big changes can be tough, though, and habits can be challenging to break. As you think of what you would like to accomplish in 2022, Mayo Clinic Health System reminds us that S.M.A.R.T. goals can help set us up for success:
Specific: Eating healthier sounds like a good goal, but what does it really mean? Aim for specific goals instead, like eliminating soda or eating three servings of vegetables a day.
Measurable: Make your goal one you can measure. Sleeping at least 8 hours a night is a goal you can track. A goal of sleeping more is not so easy to track.
Attainable: Avoid aiming too high or too low.
Realistic: Choosing realistic goals that you can meet with reinforce your efforts and motivate you to keep going.
Trackable: Choosing specific, measurable goals means you can track your progress over time. Write your efforts down or track them electronically so you can see how far you’ve come!
Specific: Eating healthier sounds like a good goal, but what does it really mean? Aim for specific goals instead, like eliminating soda or eating three servings of vegetables a day.
Measurable: Make your goal one you can measure. Sleeping at least 8 hours a night is a goal you can track. A goal of sleeping more is not so easy to track.
Attainable: Avoid aiming too high or too low.
Realistic: Choosing realistic goals that you can meet with reinforce your efforts and motivate you to keep going.
Trackable: Choosing specific, measurable goals means you can track your progress over time. Write your efforts down or track them electronically so you can see how far you’ve come!
Dear Marci,
Dear Marci,
I am working on my budget for the new year and wondering what my Medicare costs will be in 2022?
-Emma (San Jose, CA)
Dear Emma,
Your Medicare coverage and costs can change each year, so it is important to understand and review your benefits. Here is an overview of new costs in 2022.
Part A (Hospital insurance)
Part A premium:
Free if you’ve worked 10 years or more
$274 per month if you’ve worked 7.5 to 10 years
$499 per month if you’ve worked fewer than 7.5 years
Part A hospital deductible:
$1,556 each benefit period
Part A hospital coinsurance:
$0 for the first 60 days of inpatient care each benefit period
$389 per day for days 61-90 each benefit period
$778 per lifetime reserve day after day 90 in a benefit period
(You have 60 lifetime reserve days that can only be used once. They’re not renewable.)
Skilled nursing facility insurance:
$0 for the first 20 days of inpatient care each benefit period
$194.50 per day for days 21-100 each benefit period
Part B (Medical insurance)
Part B premium: $170.10
If your annual income is higher than $91,000 for an individual ($182,000 for a couple), you will pay a higher Part B premium
Part B deductible: $233 per year
Part B coinsurance: 20% for most services Part B covers
Part D (Prescription drug coverage)
National average Part D premium: $33.37 per month
Part D maximum deductible: $480 per year
Coverage gap beings: $4,430
Catastrophic coverage begins: $7,050
Note that if you have a Medigap policy, your budgeting may look a little different. You pay a monthly premium for the Medigap policy, which in turn pays part or all of certain costs after Original Medicare pays. For example, a Medigap policy can cover the cost of your Part B coinsurance or inpatient hospital deductible. Medigap premiums vary throughout the country, but in general they range from $100 to $300 per month.
If you have a Medicare Advantage Plan, your plan administers your Medicare coverage. Remember that most people with Medicare, whether they have Original Medicare or a Medicare Advantage Plan, pay the Part B monthly premium. Some people with a Medicare Advantage Plan may also pay an additional monthly premium for that plan.
If you have the same Medicare Advantage Plan in 2022 as you did in 2021, your plan should have sent you an Annual Notice of Change (ANOC) or Evidence of Coverage (EOC) notice explaining any changes for the coming year. Review this notice to understand your plan’s costs, covered services, and rules. Contact your plan if you did not receive these documents in the fall or want another copy. If you chose a new Medicare Advantage Plan, you should get an EOC for the new plan and you can review that document to understand the costs associated with the plan for 2022.
I hope this helps with your budgeting!
-Marci
Dear Marci,
I have been having difficulty moving around my home, and my doctor wants to order some kind of durable medical equipment (DME) for me. Does Medicare cover DME?
-Patricia (Kailua, HI)
Dear Patricia,
Durable medical equipment (DME) is equipment that helps you complete your daily activities. It includes a variety of items, such as walkers, wheelchairs, and oxygen tanks. Medicare usually covers DME if the equipment:
- Is durable, meaning it is able to withstand repeated use
- Serves a medical purpose
- Is appropriate for use in the home, although you can also use it outside the home
- And, is likely to last for three years or more
To be covered by Part B, DME must be prescribed by your primary care provider (PCP). If you are a skilled nursing facility (SNF) or hospital inpatient, DME is covered by Part A.
Whether you have Original Medicare or a Medicare Advantage Plan, the types of Medicare-covered equipment are the same. Examples of DME include:
- Wheelchairs
- Walkers
- Hospital beds
- Power scooters
- Portable oxygen equipment
Under the durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) category, Medicare Part B also covers:
- Prosthetic devices that replace all or part of an internal bodily organ
- Prosthetics, like artificial legs, arms, and eyes
- Orthotics, like rigid or semi-rigid leg, arm, back, and neck braces
- Certain medical supplies
Medicare Part B also covers certain prescription medications and supplies that you use with your DME, even if they are disposable or can only be used once. For example, Medicare Part B covers medications used with nebulizers. Medicare also covers lancets and test strips used with diabetes self-testing equipment.
Note that there are also certain kinds of equipment and supplies that Medicare does not cover, such as equipment for use mainly outside the home, and most equipment that is thrown out after one use or not used with equipment.
To find out if Medicare covers the equipment or supplies you need, or to find a DME supplier in your area, call 1-800-MEDICARE or visit www.medicare.gov. You can also learn about Medicare coverage of DME by contacting your State Health Insurance Assistance Program (SHIP).
-Marci
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