Life After 50 Expo

Goals for the New Year!

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The start of a new year can be a good time to look ahead and set goals.

One common goal for adults is to incorporate more physical activity into our lives. If our bodies are not used to much physical activity, though, it can be tough to get started or to reach our goals. The National Institute on Aging has some helpful tips on how older adults can get started with exercise
.First, start slowly! Begin with low-intensity exercises for short amounts of time and work your way up. Also incorporate warm-ups before exercising and cool-downs afterwards to ease your body in and out of activity.
Consider talking to your doctor about exercise. You can ask questions like: Are there exercises or activities I should avoid? Is my preventive care up-to-date? How does my health condition affect my ability to exercise?
Finally, write down and track your fitness goals. It can be helpful to have short-term goals (for example, in the next two weeks I will make sure I have the shoes and comfortable clothes I need to start walking for exercise) and long-term goals (for example, next summer I will be able to play catch with my grandchild).Whatever your goals are for this year—big or small, fitness-related or not—they are worth pursuing!

Dear Marci,

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Dear Marci,

I have been thinking about making changes to my Medicare coverage. I know there are specific times of the year during which I can make changes, though. When can I change my Medicare coverage in 2021?

– Alexandra (Roswell, NM)

Dear Alexandra,

Yes, there are certain periods of time when you can make changes to your Medicare coverage. These periods of time are called enrollment periods.

If you have a Medicare Advantage Plan, you may be able to use the Medicare Advantage Open Enrollment Period (MA OEP).The MA OEP occurs each year from January 1 through March 31.During the MA OEP you can switch from your Medicare Advantage Plan to another Medicare Advantage Plan or to Original Medicare with or without a prescription drug plan.You may only make one change during this period, and it will be effective the first of the next month after you make the change.Remember, you can only use this enrollment period if you have a Medicare Advantage Plan.Depending on your circumstances, you may qualify for a Special Enrollment Period (SEP) to change your Medicare health and drug coverage.There are many circumstances in which you may have a Special Enrollment Period (SEP), such as if you moved outside of your plan’s service area, your Medicare Advantage Plan terminated a significant amount of its network providers, or you are enrolled in a State Pharmaceutical Assistance Program (SNAP).Those with Extra Help, the federal program that helps pay for drug costs, have an SEP to enroll in a Part D plan or switch between plans once per quarter in the first three quarters of the year.If you need to make changes to your coverage but you are not sure whether you qualify for an SEP, call your State Health Insurance Assistance Program (SHIP) to learn more. If you do not know how to contact your SHIP, call 877-839-2675 or visit www.shiptacenter.org.If you enrolled in a plan by mistake or because of misleading information, you may be able to disenroll and change plans.Typically, you have the right to change plans if you joined unintentionally, joined based on incorrect or misleading information, or, through no fault of your own, were kept in a plan you did not want.You can call 1-800-MEDICARE to explain to a customer service representative how you joined the plan by mistake and to request retroactive disenrollment or a Special Enrollment Period.Finally, both individuals with Original Medicare and those with a Medicare Advantage Plan can make changes during Fall Open Enrollment.The Fall Open Enrollment Period occurs each year from October 15 through December 7.During this period you can join a new Medicare Advantage Plan or stand-alone prescription drug plan (Part D) plan. You can also switch between Original Medicare with or without a Part D plan and Medicare Advantage.You can make as many changes as you need during this period, and your last coverage choice will take effect January 1.As you can see, there are various enrollment periods in which you can change your Medicare coverage. Which enrollment period you use depends on your specific circumstances and the kind of coverage you have.

– Marci

Dear Marci,

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Dear Marci,

I have been recovering from surgery at a skilled nursing facility (SNF), but recently was told I am being discharged this week. How can I appeal my discharge from a SNF?

– Matthew (Rochester, NY)

Dear Matthew,

If you are receiving care in a non-hospital setting and are told that Medicare will no longer pay for your care (and you will be discharged), you have the right to file a fast appeal if you do not believe your care should end. Non-hospital settings include skilled nursing facilities, Comprehensive Outpatient Rehabilitation Facilities (CORFs), hospice, or home health agencies.

If your care at a non-hospital setting is ending because your provider believes Medicare will not pay for it, you should receive a Notice of Medicare Non-Coverage. You should get this notice no later than two days before your care is set to end. If you receive home health care, you should receive the notice on your second to last care visit. If you have reached the limit in your care or do not qualify for care, you do not receive this notice and you cannot appeal. 

If you feel that your care in a non-hospital setting should continue, follow the instructions on the Notice of Medicare Non-Coverage to file an expedited appeal with the Quality Improvement Organization (QIO) by noon of the day before your care is set to end. Once you file the appeal, your provider should give you a Detailed Explanation of Non-Coverage. This notice explains in writing why your care is ending and lists any Medicare coverage rules related to your case. 

The QIO will usually call you to get your opinion. You can also send a written statement. If you receive home health or CORF care, you must get a written statement from a physician who confirms that your care should continue. 

If you have Original Medicare, the QIO should make a decision no later than two days after your care was set to end. If you have a Medicare Advantage Plan, the QIO should make a decision no later than the day your care is set to end. Your provider cannot bill you before the QIO makes its decision. If the QIO appeal is successful, you should continue to receive Medicare-covered care, as long as your doctor continues to certify it.

If your appeal is denied at this first level, you can continue to appeal by following instructions on the denial notices you receive. There are five levels of appeal in total; the timing and agency involved depend on whether you have Original Medicare or a Medicare Advantage Plan. You have the right to continue appealing if you are not successful. 

Expedited appeals have tight deadlines, so it is important to pay attention to the timeframes for appealing at each level. Keep copies of any appeal paperwork you send out, and if you speak to someone on the phone, get their name and write down the date and time that you spoke to them. It is helpful to have all of your appeal documents together in case you run into any problems and need to access documents you already mailed.  

Note that the appeal process is different if your inpatient hospital care is ending or if your care is being reduced but not ending, and you do not agree with that reduction.

– Marci

SAD explained!

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Seasonal affective disorder (SAD) is a type of depression related to changes in seasons. For most, people with SAD feel symptoms begin in late fall or early winter and affect their energy, mood, and behavior through the end of winter. With fewer hours of sunlight and less socializing with others right now, SAD symptoms may affect many of us this winter. Rather than brush off the “winter blues,” recognize that you are not alone and that you can take steps to steady your mood throughout the year. Lifestyle and home changes (such as making your environment sunnier, getting outside, and exercising) can alleviate milder SAD symptoms. And while it’s normal to have some days where you feel down, you should see your doctor if you feel down for days at a time or you can’t get motivated to do activities you normally enjoy. To read more about SAD symptoms and treatments, visit Mayo Clinic. For 24/7 treatment referral and information, contact the SAMHSA National Helpline at 800-662-HELP (4357).

 
 

Dear Marci,

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Dear Marci,

I have been an inpatient at a hospital for a week, and I just received a notice that Medicare will no longer pay for my stay. I will be discharged from the hospital in two days, but I don’t think I have recovered enough to leave yet. How can I appeal my discharge from a hospital?

– Ruby (South Bend, IN)

Dear Ruby,

If you are receiving care in a hospital and are told that your Medicare will no longer pay for your care (and you will be discharged), you have the right to file a fast appeal if you do not believe your care should end.

If you are a hospital inpatient, you should receive a notice titled Important Message from Medicare within two days of being admitted. This notice explains your patient rights, and you will be asked to sign it. If your inpatient hospital stay lasts three days or longer, you should receive another copy of the same notice up to two days, and no later than four hours, before you are discharged. 

If you think you are being discharged too soon, follow instructions on the Important Message from Medicare to file an expedited appeal to the Quality Improvement Organization (QIO). Contact the QIO by midnight of the day of your discharge. 

Once you file the appeal, the hospital must give you a Detailed Notice of Discharge, which explains in writing why your hospital care is ending. The QIO should call you with its decision within 24 hours of receiving all the information it needs. 

If the QIO decides your care should end, you will be responsible for paying for any care you receive after noon of the day after the QIO makes its decision. If your appeal to the QIO is successful, your care will continue to be covered.

If your appeal is denied at this first level, you can continue to appeal by following instructions on the denial notices you receive. There are five levels of appeal in total; the timing and agency involved depend on whether you have Original Medicare or a Medicare Advantage Plan. You have the right to continue appealing if you are not successful. If you are unable to appeal, a family member or other representative can appeal for you. 

Expedited appeals have tight deadlines, so it is important to pay attention to the timeframes for appealing at each level. Keep copies of any appeal paperwork you send out, and if you speak to someone on the phone, get their name and write down the date and time that you spoke to them. It is helpful to have all of your appeal documents together in case you run into any problems and need to access documents you already mailed. 

– Marci