Life After 50 Expo

Medicare Service Payments Set !

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The Centers for Medicare & Medicaid Services (CMS) recently issued final details about how Medicare will pay for services provided by physicians and other health care professionals in 2016. These updated rules attempt to reward quality, value, and patient-centered care.

In a statement accompanying the release of the final rules, CMS Acting Administrator Andy Slavitt said, “CMS is pleased to implement the first fee schedule since Congress acted to improve patient access by protecting physician payments from annual cuts. These rules continue to advance value-based purchasing and promote program integrity, making Medicare better for consumers, providers, and taxpayers.”

Among the previous proposals finalized in this rule is one allowing physicians to bill for advanced care planning conversations. Medicare Rights previously commented in support of this proposal and is happy to see it in the final rule. The rule also provides additional needed clarification regarding how physicians should determine whether a patient should be admitted as an impatient to a hospital using a ‘two midnight rule’ to guide, but not supplant, professional judgment.

Budget Agreement Stops Medicare Premium Increase !

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This week, the President signed into law a two-year budget agreement that prevents the projected significant increase in the Medicare Part B premium and deductible for 2016.

Premiums for 30 percent of beneficiaries were projected to increase from $104.90 to over $150 because of several factors, including higher than projected Medicare outpatient costs in 2015 and the lack of a cost-of-living increase for Social Security recipients. Other beneficiaries who have their Part B premium deducted from their Social Security check were already “held harmless” and protected from increased Part B premiums where there is no increase in their check. This meant that the increase fell on a smaller group, and was therefore larger for each affected person.  

The fix passed in the budget will make the premium for next year about $120 instead of $150 or more. Additionally, the Part B deductible, or amount people have to pay out of pocket before their coverage begins, was also set to increase to about $223. The deal reduces the projected deductible to $167.

To limit the magnitude of the premium increase, the fix looks to what the premium would have been had the increase been spread across all enrollees, and it “loans” the difference from the Medicare trust fund to the 30 percent of beneficiaries affected by the increase. These beneficiaries as a group will have to repay that loan by paying a $3 per month surcharge.

Final amounts for the Part B premium and deductible should be released soon.

Supplementing Your Medicare Coverage !

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Medigap policies are health insurance policies sold by private insurance companies. Medigaps are sometimes known as Medicare Supplement Insurance.  If you have a Medigap policy, Original Medicare first pays its share for your care, and then Medigap pays all or part of the remaining costs, including deductibles, coinsurance and copayments. Medigaps may also cover some health care that Medicare doesn’t cover at all. Medigaps only work with Original Medicare; they don’t work with Medicare Advantage plans.

Learn when you have the right to buy a Medigap so you can time your enrollment wisely. In most states, you have a limited window of time to buy a Medigap policy if you are age 65 or older. If you are under age 65, your ability to enroll in a Medigap is typically more limited.

– Once you decide you need a Medigap and you are able to enroll into a Medigap, compare the different types of policies that exist. There are 10 different standardized policies and you need to select the best one for you.

– Learn how a Medigap should cover prior medical conditions to know if any of your medical costs may be excluded. Depending upon your circumstances, a Medigap can exclude coverage for prior medical conditions for a limited amount of time.

– Find out how Medigap premiums are priced so you can make adequate cost comparisons.  It’s important to understand the ways that insurers set premiums to find the best deal for you.

– Have a list of questions to ask when you shop for a Medigap to remind you what you should consider.  Buying a Medigap can be a confusing experience. Rely on written questions can help you stay organized and simplify the process.

  • If you are confused about Medigaps, how to enroll, or what policy is best for you, contact your State Health Insurance Assistance Program (SHIP). You can find the number for your SHIP by visiting http://shiptalk.org. For additional information on Medigap policies in your state, you can also contact your State Department of Insurance.Med

Dear Marci,

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Dear Marci,

My father is terminally ill, and I have been doing research about possible options for his care. I came across information about hospice care, but I am not sure what it is. Does Medicare cover hospice, and if so, what are the requirements?

– Erik (Allentown, PA)

Dear Erik,

Hospice is a type of health care intended to provide compassionate, comprehensive, quality care for individuals with a terminal illness who are facing the end of life. Hospice care focuses on providing comfort and pain management (palliative care), rather than curative treatments for an illness. It usually involves a team approach to care, with doctors, nurses, social workers, and other professionals coordinating care that focuses on physical, emotional, and spiritual needs.

Original Medicare will cover hospice care if your father meets all of the following criteria:

  • He has Medicare Part A
  • The hospice medical director (and his doctor, if he has one) certifies that your father has a terminal illness (his life expectancy is six months or less)
  • Your father signs a statement electing to have Medicare pay for palliative care such as pain management, rather than care to try to cure his condition
  • His terminal condition is documented in his medical record
  • He receives care from a Medicare-certified hospice agency

An individual does not need to be homebound to qualify for the Medicare hospice benefit. The benefit is a comprehensive set of services delivered by a team of providers. A lot of hospice services are provided in the home, but inpatient care is covered under specific circumstances.

The hospice benefit is always covered under Original Medicare. If your father has a Medicare Advantage Plan and elects hospice, Original Medicare will automatically pay for his hospice care. His Medicare Advantage Planwill continue to pay for care that is unrelated to his terminal condition. For example, if your father breaks his hip while in hospice, his Medicare Advantage Plan would pay for hip-related care.

The Medicare hospice benefit covers many different services, including skilled nursing care, prescription drugs related to pain relief and symptom control, spiritual counseling, and more. Medicare will cover these services if they are listed on a beneficiary’s plan of care.

The hospice benefit includes two 90-day hospice benefit periods followed by an unlimited number of 60-day benefit periods. Your father must have a face-to-face meeting with a hospice doctor or nurse practitioner if he reaches his third benefit period. The third benefit period begins on day 180 of hospice. After that, your father must have face-to-face meetings with a hospice doctor or nurse practitioner before the start of each subsequent 60-day benefit period. The meeting must take place no earlier than 30 days before the new benefit period to confirm that your father still qualifies for hospice care.

If you think your father is eligible for hospice services, you two should speak with his doctor about this care, and request that his doctor contact a Medicare-certified hospice on his behalf. There may be several Medicare-certified hospice facilities in your area. If the first one that you contact is unable to help, try contacting others.

– Marci

ElderSource Offers Medicare Info !

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From October 15 to December 7, seniors 60 years and old have the opportunity to review their Medicare insurance plans and make changes to their policies, if desired or necessary. What does this mean to ElderSource?  Our SHINE volunteers (Serving Health Insurance Needs of Elders) will be making presentations, counseling seniors and caregivers on how to best utilize their Medicare benefits.
SHINE is a program of the Department of Elder Affairs and is operated locally through ElderSource to offer seniors, persons with disabilities and their caregivers free and unbiased counseling on Medicare and health insurance issues. ElderSource has over 50 specially-trained SHINE volunteers ready to help!  For a SHINE presentation or to set an appointment, call 904-391-6600.