Life After 50 Expo

Healthy eating for dialysis patients !

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It is important to strive for healthy eating. For dialysis patients, a proper diet can help maintain energy, bone health, heart health, and strength. The National Institutes of Health (NIH) Senior Healthrecommends that individuals who receive hemodialysis should monitor the amount of liquids they drink and avoid foods that are high in sodium, potassium, and phosphorus. All types of dialysis remove protein from an individual’s body, so it is important to eat protein-rich foods like meat and eggs. NIH also recommends that dialysis patients speak with the renal dietician at their dialysis center or transplant clinic to learn more about their specific dietary needs and develop a meal plan to support their treatment.   

Need to Know

Dear Marci,

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Dear Marci,

What changes can I make during Fall Open Enrollment?

– Herman (Chattanooga, TN)

Dear Herman,

Fall Open Enrollment, also known as the Annual Election Period, runs from October 15 to December 7 each year. This is the time of the year when Medicare beneficiaries can make changes to their existing coverage.

If you are enrolled in a Medicare Advantage Plan or a stand-alone Part D plan, your plan should send you an Annual Notice of Change (ANOC) that lists any changes to your plan for 2017. These changes could be that the plan will charge a different monthly premium, cover different services, or change its formulary (the plan’s list of covered drugs).

You should read this notice carefully to see if any of the changes affect you. For instance, if your ANOC tells you that your Part D plan will have an annual deductible next year, you may want to choose a new Part D plan that does not have a deductible.

There are a number of changes you can make during Fall Open Enrollment. You can:

  • Switch from Original Medicare to a Medicare Advantage Plan (also called Part C)
  • Switch from a Medicare Advantage Plan back to Original Medicare
  • Switch from your current Medicare Advantage Plan to a new one
  • Join a Part D prescription drug plan (if you do not have one)
  • Switch from your current Part D prescription drug plan to a new one
  • Do nothing and stay with your current coverage

Any changes you make will become effective January 1, 2017. You can make as many changes as you like during Fall Open Enrollment, but only the last change you make will be effective in January.

If you have questions about your coverage, plan options, or just need help in general, there are a number of resources you can use for assistance:

  • Call 1-800-MEDICARE. You can call Medicare to learn about plan options in your area, confirm your current coverage, or change your coverage.
  • Visit www.medicare.gov/find-a-plan. You can use this online tool to search for and compare plans.
  • Call a Medicare Advantage Plan or a stand-alone Part D plan. By calling your plan you can learn about coverage and costs for the upcoming year, request a copy of the plan’s formulary, or enroll in the plan.

Fall Open Enrollment is a time to consider all of your health care options and needs. Even if you decide not change how you receive your Medicare benefits, it is a good idea to review your coverage and any changes that the plan may put in place for 2017.

– Marci

Traveling Food Safety Tip !

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It’s important to practice food safety while traveling, even within the United States, as food poisoning can occur anywhere. It is especially important to wash your hands with soap and water before you eat and to keep an alcohol-based hand sanitizer with you for situations when you don’t have access to a sink. The Academy of Nutrition and Dietetics provides a number of other recommendations for food safety while traveling:

  • Be wary of buffets, as the food may not be kept fresh.
  • If you buy hot or cold food at an airport or rest stop, be sure to eat it within 2 hours so that bacteria don’t have enough time to multiply.
  • Fish, shellfish, meat, and eggs are always unsafe to eat raw, even if you are at a fancy restaurant or hotel.
  • Clean off tray tables or picnic tables before placing your food down, and never place your food directly on those surfaces.
  • When in doubt, don’t drink well or tap water.

Dear Marci.

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Dear Marci,

How does the Health Insurance Marketplace affect my Medicare coverage?

– Josephine (Cumberland, RI)

Dear Josephine,

The Marketplace (also known as the Exchange) does not change your Medicare benefits or how you access them. Individual Marketplaces provide a way for people who lack health insurance to get coverage. However, Marketplace policies, also known as Qualified Health Plans (QHPs), are not meant for people who qualify for Medicare. Medicare Advantage Plans, Medigaps, and stand-alone Part D plans are not sold through the Marketplace.

If you are eligible for Medicare, in most cases you should not use the Marketplace to get health and drug coverage. Limited exceptions include if you qualify for Medicare based on having End-Stage Renal Disease (ESRD), or if you do not qualify for premium-free Part A. In these cases, a Marketplace plan might be an option for you.

Otherwise, if you already have Medicare, there are a few reasons you should not enroll in a QHP:

  1. It is illegal for someone to sell you a QHP if they know you have Medicare.
  2. You are not eligible for any tax credits to help pay for QHP premiums. QHP premiums are more costly than your Medicare, Medigap, or Part D premiums.
  3. There is no guarantee that a QHP will pay for your health costs if you were to drop Medicare to take a QHP.

If you are enrolled in a QHP and then become eligible for Medicare, there are steps you should take to enroll in Medicare. These steps will help you avoid gaps in coverage or penalties:

  1. You should enroll in Medicare as soon as you are eligible.
  2. You should drop you QHP coverage. If you get your coverage through the federal Marketplace, disenroll by calling the Marketplace Call Center or by going online atwww.healthcare.gov. If you get your coverage through a state-based Marketplace, contact your plan or the state-based Marketplace to find out how to disenroll.
  3. After you enroll in Medicare, consider how you want to get your Medicare coverage. Medicare beneficiaries have the choice between Original Medicare through the federal government and a Medicare Advantage Plan through a private insurance company.

If you have a Small Business Health Options Program (SHOP) plan that your current employer purchased through the Marketplace, then the rules are a little different. If you have a SHOP plan through a current employer, you will still need to enroll in Medicare; however, the timing of your enrollment and whether Medicare will pay first or seconddepends on the size of your employer and whether you qualify for Medicare based on age or disability. If you have a SHOP plan, talk with your employer about how your coverage works with Medicare.

You may hear a lot about the Health Insurance Marketplaces, but just know that apart from for limited exceptions, Medicare beneficiaries do not need to use them to get their health care coverage.

– Marci

Health Tip

Medicare Appeal Rights

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If you have been denied coverage for a health service or item, you should appeal this decision. An appeal is when you ask Medicare or your plan to reconsider its coverage decision. You can appeal whether you have Original Medicare, a Part D prescription drug plan, or a Medicare Advantage Plan.

Before you start your appeal, make sure you fully read all the letters you receive from Medicare or your plan. Contact Medicare or your plan to find out the reason your health service or item is not being covered, if the information has not been provided. Specifically mentioning the reason for denial in your appeal letter will increase the chance of winning your appeal. Additionally, appeals are more successful if you have a doctor’s letter of support that also specifically mentions the reason for denial.

There is more than one level of appeal, and you should continue appealing if you are not successful at the first level. Appeal levels and timeframes differ. Make sure you follow the steps and stay within the timeframes of the appeal process that applies to your situation. If you do not follow these rules, your appeal may not be considered.

Keep in mind that an appeal is different from a grievance. A grievance is an official complaint that you file with your plan.