Life After 50 Expo

Dear Marci,

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Dear Marci,

My Medicare Advantage Plan sent me a notice called an Explanation of Benefits. What is this notice, and how do I make sense of it?

– Louis (Cape Elizabeth, ME)

Dear Louis,

An Explanation of Benefits (EOB) is a notice that your Medicare Advantage Plan typically sends you after you receive health care services or items. EOBs are usually mailed once per month and may be available online. An EOB is not a bill; it is a summary of services or items you received.

Each plan formats its EOB differently, but in general your EOB should tell you:
  1. How much your provider billed the plan.
  2. How much your plan will pay. This amount may be different from the amount your provider billed. This is because plans have negotiated rates with providers that work with the plan, and the plan will only pay up to its approved amount for services.
  3. How much you may owe. This column may be called “patient responsibility.” As noted, the EOB is not a bill. It is simply informing you of the amount you may owe. Your provider will send you a bill for the services you received. You may be responsible for a bill if you owe a copayment or coinsurance, have not yet reached your deductible, or if your service was denied coverage.
In addition to the information it provides, an EOB is important because it is the notice that allows you to begin an appeal. An appeal is when you ask your health insurance plan to reconsider its decision to deny coverage of a service or item you received. If your EOB shows that your plan did not approve payment or coverage for a service you received, you can appeal. Look for footnotes on the EOB that explain why the service was denied. This will be useful in writing your appeal.

There should be instructions about how to appeal included on the last page of your EOB, and you will need to start your appeal within 60 days of the date of  the notice. If possible, it is a good idea to ask your provider to help with the appeal by including relevant medical records and a letter of support.

EOBs contain important information about your appeal rights and the services you received. You should read these notices carefully and contact your plan and provider if you have any questions, or if you see services listed that you don’t recognize.

– Marci

 

CMS Proposes New Ways to Pay for Part B Covered Medications !

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Recently, the Centers for Medicare & Medicaid Services (CMS) Innovation Center proposed a demonstration to test new strategies to pay for medications that are covered under Part B. Most prescription medications are covered under Medicare Part D, but some (mostly those administered by a doctor) are paid for under the outpatient Part B benefit.

Common Part B prescription drugs treat cancer, macular degeneration, anemia, and arthritis. Part B medications tend to be very expensive—in 2013, Medicare and its beneficiaries spent $19 billion on Part B prescriptions. The proposed demonstration is designed to evaluate different strategies for pricing medications to discover the policy that will best ensure that people with Medicare receive the highest value Part B medications available.

Currently, Medicare pays for Part B prescription drugs according to a simple formula—the Average Sales Price of the prescription drug plus a 6 percent markup to cover the cost of handling and administration. The proposed demonstration has two phases. First, the Innovation Center will alter the percentage markup to a flat handling fee plus 2.5 percent of the cost of the medicine. CMS hopes that this will decrease the incentive for providers to choose more expensive medicines under the current payment strategy.

In the second phase, the Innovation Center will test strategies to adjust the base price to reflect the medication’s value to beneficiaries. These include:

  • reducing the base beneficiary cost-sharing of 20 percent for high-value options;
  • setting a standard price for medications that function similarly;
  • paying more for a medication that is used to treat a condition when it has high effectiveness, and less for the same medication that is used to treat illnesses when it may be less successful; and
  • obtaining rebates or refunds from pharmaceutical companies if medications are less effective than expected.

As a long-time advocate for solutions to lower the cost of Part B medications, Medicare Rights supports the proposed demonstration and will provide comments to the Innovation Center on how to proceed with testing to ensure that beneficiaries continue to receive the treatments best suited to their needs.

For older adults with dementia, transitions in care can increase risk for serious problems !

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A transition is a physical move from one location to another with a stay of at least one night. For older adults, especially those with dementia, some transitions may be unavoidable and necessary. However, unnecessary transitions are linked to problems such as medication errors, hospital readmissions, and increased risk of death. What’s more, good dementia care emphasizes the need for familiar people and familiar environments, and this can be more difficult to support when too many transitions take place. Having coordinated care and a long-term care plan in place that considers the needs of a person with dementia may reduce unnecessary transitions, say the authors of a study published in the Journal of the American Geriatrics Society.

In their study, researchers from the UBC Centre for Health Services and Policy Research in Vancouver, British Columbia, followed 6,876 people aged 65 and older who were diagnosed with dementia between 2001 and 2002. The researchers analyzed healthcare data from 2000 until the study ended in 2011. Besides dementia, 23 percent of the group had no other chronic diseases at the beginning of the study, while 44 percent of the group had two or more chronic diseases.

The researchers found a spike in the number of transitions during the first year of dementia diagnosis. Sixty-five percent of the study participants experienced at least one transition during the year of their diagnosis; 17 percent experienced three or more transitions, most of which were hospitalizations. More than 60 percent of people were hospitalized in the year of their diagnosis, and these hospital stays generally lasted for a month or longer.

To continue reading click below:

http://www.medicalnewstoday.com/releases/308242.php

 
 

Water Aerobics for Your Health !

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Following Fishes for Losing the Pounds: Water Aerobics

There are many different ways that you can get healthy – doing water aerobics is something you might never have thought of. However, not only can it help you be really healthy and get the most out of your aerobic work out, it can do a lot more, as well.

When it comes to using the water to work out, there are many ways that water aerobics can work for you. You can either do some of these exercises on your own, or you can join a club or a group that will teach you how to do them. No matter what you decide to do, you’ll be able to find that water aerobics fit right in to your regular work out routine.

Basically, doing water aerobics means that you are going to be providing your body with actual exercise. You are going to be doing aerobic work outs in much the same manner that you would if you weren’t in the water – for instance you are going to be able to run, walk, and do other movements during your work out. The difference is that you’ll be doing them in the water, which adds to the work out.

By doing your workout in the water, you are getting more resistance than if you were doing it in the air. Everyone knows that when you try to move through water you have to exert more force in order to make the movements that you want to make. This means that as you do your water aerobics, you are forced to use more of your muscle groups and you are forced to get stronger.

Most of the time you can be with a water aerobics class, which will help you figure out how best to do your water aerobics. This is a great way to make sure that you know what you are doing, and to make sure that you are actually getting as much out of your exercise as you can. The instructor will guide the class through a series of movements, where you’ll be able to do the same repetitive motions over and over again. Hopefully, you’ll find that this will increase your heart rate and allow you to be able to start to work your body in a great and aerobic way. By doing water aerobics, you can get exercise and strengthen every part of your body – plus, water aerobics can be the most fun you’ve had in a pool since you were a little kid!

Stress management may enhance cardiac rehab, improve recovery !

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Heart patients may benefit from cardiac rehabilitation (rehab) programs even more when stress management is added, according to new research in the American Heart Association’s journal Circulation.

“Cardiac rehabilitation programs do not routinely offer stress management, but this may change should demand increase. And because patients may be reluctant to ask for the programs themselves, the onus is on the physicians to recognize that stress management is important for the optimal medical management of patients,” said James A. Blumenthal, Ph.D., professor of Psychiatry and Behavioral Sciences at Duke University School of Medicine in Durham, North Carolina.

After a median follow up of more than three years, researchers found that patients who underwent cardiac rehab plus stress management achieved greater benefits than rehab alone. Cardiac events such as heart attack, stroke, recurrent chest pains requiring hospitalization, or even death were observed in:

  • 18 percent of patients in the rehab plus stress management group;
  • 33 percent of patients in the cardiac rehab only group; and
  • 47 percent of patients in those who had no rehab.
  • to continue reading click below:
  • http://www.medicalnewstoday.com/releases/308121.php