Life After 50 Expo

Health Tip !

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The New Year is a great time to consider the state of your health and create new health goals for 2015. TheCenters for Disease Control and Prevention publishes various health tips and toolkits to help you create new health and fitness goals and stick to them. Some small steps to take for a healthy 2015 are:

  • Make smart food choices, such as substituting salty snack foods for fruit or drinking water instead of soda;
  • Exercise regularly and explore new opportunities for physical activity, such as fitness classes;
  • Get enough sleep, as sleep is important at all ages for good health.

To read more tips for a health new year, click here.

Medicare covers many preventive services benefits at no cost to beneficiaries, such as an Annual Wellness Visit, counseling to help you quit smoking, and obesity screenings and counseling. Speak with your doctor to learn more about these services, and other preventive care benefits that can protect and promote your health.
Need to Know
If you received a notice in the mail that your Medicare Advantage plan is ending on December 31, 2014, you have a Special Enrollment Period to enroll in a new Medicare Advantage plan, or switch to Original Medicarewith a Medigap policy and a stand-alone Part D plan for prescription drug coverage. To avoid any gaps in coverage, make your coverage decision by December 31, 2014.

To read more about your options, click here. If your Medicare Advantage plan is ending and you receive Extra Help, click here.

44 Organizations Sign Letter Advocating Better Notification System for Those Approaching Medicare Eligibility

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Last week, 44 organizations, including the Medicare Rights Center, urged the Department of Health and Human Services, the Department of Labor and the Social Security Administration to implement a system for notifying individuals approaching Medicare eligibility to inform them of their rights and obligation as they near enrollment.

The organizations asked that the agencies to ensure that all individuals nearing Medicare eligibility receive timely and complete notice about Medicare enrollment. According to the letter, such a system will ensure that fewer people new to the Medicare program are saddled with higher health care costs or go without needed health care services due to gaps in coverage and late enrollment penalties resulting from missing enrollment windows.

In particular, the letter suggests the following:

  • Provide notice about nearing Medicare eligibility to all individuals turning age 65;
  • Ensure that notices include key messages about coordination of benefits and delaying enrollment;
  • Carefully engage other messengers, including health plans, employers and states;
  • Strengthen notice for those who are auto-enrolled into Medicare; and
  • Develop notices and educational materials in additional languages and alternate formats.

Medicare Reminder !

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Medicare will cover emergency and non-emergency ambulance services if:

– The services are medically necessary, meaning that an ambulance is the only safe way to transport you and the reason for your trip is to receive a service or to return from a service that you need and Medicare will cover;

– You are transported to and from certain locations; and

– The supplier of the ambulance services meets Medicare’s ambulance requirements.

An emergency is when your health is in serious danger and every second counts to prevent your health from getting worse.

If the trip is scheduled as a way to transport you from one location to another when your health is not in immediate danger, it is not considered an emergency. If it is not an emergency, Medicare coverage of ambulance services is very limited.

Medicare may cover non-emergency ambulance services if:

– You are confined to your bed (unable to get up from bed without help, unable to walk, and unable to sit in a chair or wheelchair); or

– You need vital medical services during your trip that are only available in an ambulance, such as administration of medications or monitoring of vital functions.

Read more about Medicare coverage of ambulance transportation and new requirements for certain non-emergency ambulance rides in New Jersey, Pennsylvania or South Carolina, on Medicare Interactive.

CMS Expands Prior Authorization for Non-Emergency Ambulance Transport in Original Medicare

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Beginning with dates of service on or after December 15, 2014, providers of Medicare Part B covered ambulance services in South Carolina, New Jersey and Pennsylvania will be required to obtain prior-authorization before Original Medicare will cover certain medically necessary non-emergency ambulance rides. The new prior authorization requirements are part of a three-year demonstration. Repetitive ambulance rides are commonly used by patients receiving kidney dialysis or certain cancer treatments, and they are defined as ambulance rides provided to patients three or more times during a ten-day period, or rides provided at least once a week for three or more weeks.

Through this demonstration, CMS hopes to address what they view as a higher than usual rate of ambulance billing fraud in these three states. Upon request, beneficiaries receiving non-emergency ambulance rides will be notified whether Medicare will pay for their non-emergency transportation in advance. Otherwise, the ambulance provider will be notified. Requiring prior authorization is a contrast to procedures that apply in Original Medicare, where beneficiaries receiving non-emergency ambulance transportation can be impacted by unexpected ambulance costs when those claims are denied as not meeting Medicare’s coverage requirements, after services have already taken place.

Individuals who rely on non-emergency ambulance transportation are often more medically vulnerable and frail than other Medicare beneficiaries. It is important that beneficiaries, providers and their advocates proactively work to ensure prior-authorization is obtained and any problems are addressed in a timely manner.

Medicare Reminder !

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A transition refill, also known as a transition fill, is typically a one-time, 30-day supply of a drug that Medicare drug plans must cover when you’re in a new plan or when your existing plan changes its coverage. Transition fills let you get temporary coverage for drugs that aren’t on your plan’s formulary or that have restrictions on them. Transition fills aren’t for new prescriptions. Every year, Medicare drug plans may change which drugs they cover and the rules and restrictions associated with obtaining coverage for those drugs. December 7 is the last day to enroll in or change Medicare health or drug plans this year, unless you qualify for a Special Enrollment Period (SEP). Changes made by December 7 take effect on January 1, 2015.

You can only get transition fills for drugs you were already taking before switching plans or before your existing plan changed its coverage. All Medicare Part D drug plans must cover transition fills. The rules apply to both Medicare Advantage plans that include drug coverage and Medicare stand-alone drug plans. 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 a request with the Part D plan (called an exception request) to ask for coverage.

Click here to learn more on Medicare Interactive.