| We are currently in the 2014-2015 flu season, and it is important for all individuals, especially older adults, to educate themselves about flu prevention. The best way to prevent yourself from getting the flu is by getting a flu shot during each flu season. According to the Centers for Disease Control and Prevention, approximately 20 percent of Americans get the flu each year. Even very healthy individuals can get sick from the flu. The best way to prevent yourself from getting the flu is by getting a flu shot during each flu season. It is best to get a flu shot early in the flu season, which starts during the fall. You can ask your doctor or pharmacy for more information about flu shots and where to get one.Click here for more information about the flu vaccine.
Medicare Part B will cover 100 percent of the costs for a flu shot during each flu season, as long as you see a provider who accepts Medicare assignment. If you have a Medicare Advantage plan, the plan may require that you use providers in the plan’s network. For more information on Medicare coverage of flu shots, click here. |
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Fall Open Enrollment is here!
During Fall Open Enrollment (October 15-December 7), you may make changes to your Medicare health and drug coverage. If you need help deciding your Medicare coverage for 2015, call the Medicare Rights Center’s free, national consumer helpline at 800-333-4114. |
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Dear Marci,
Dear Marci,
I got a pamphletfrom my doctor’s office reminding me to get all necessary vaccines. I want to talk to my doctor about getting these vaccines, but I’m not sure how Medicare will cover them. How does Medicare cover vaccines?- Eddie (Denver, CO)
Dear Eddie,
Medicare covers vaccines differently depending on which vaccine you need. Most vaccines are covered under Part D, but some are covered under Part B. Different costs apply to vaccines depending on how they are covered.
Medicare Part B covers vaccines if you have been exposed to a dangerous disease. For example, if you step on a rusty nail, Medicare will cover a tetanus shot. Additionally, Medicare Part B covers the influenza, pneumonia, and Hepatitis B vaccines as preventive services. These vaccines are covered by Part B if you have Original Medicare or a Medicare Advantage plan.
If you receive a Part B-covered vaccine after exposure to a dangerous disease, you will pay the normal cost sharing for Part B services. If you have Original Medicare, Medicare will cover 80 percent of the cost, and you or your supplemental insurance will be responsible for 20 percent once you have met your Part B deductible. If you have a Medicare Advantage plan, you will typically pay a copay for this service. Contact your Medicare Advantage plan directly to ask about specific vaccine costs. If you receive one of the three preventive vaccines covered under Part B, Original Medicare will cover the costs with no coinsurance or deductible, as long as you see a provider that accepts Medicare assignment. A Medicare Advantage plan will cover the costs with no coinsurance, copays or deductibles as long as you see an in-network provider.
All other vaccines are covered by Medicare Part D. Both Medicare Advantage prescription drug plans and stand-alone Part D plans must include all commercially available vaccines on their drug formularies, including the vaccine for shingles (herpes zoster). However, for these vaccines covered by Part D, you may pay different amounts depending on where you get vaccinated. Check directly with your plan for coverage rules and costs.
In general, you will pay the least for a Part D-covered vaccine if you receive the shot at a pharmacy that is in your plan’s network, or at a doctor’s office that will bill your Part D plan directly for the cost of the vaccination process. When you are at your doctor’s office, ask your doctor to call your Part D plan first to find out if there is a way that your doctor can bill your plan for the vaccine. There may be a way for the doctor to submit the bill so that you will not have to pay the whole cost up front.
If your doctor cannot submit the bill for the vaccine to your Part D plan through a partnering pharmacy, or cannot directly bill the plan for the drug, you may need to pay more for your vaccination. If this happens, your doctor will bill you for the entire cost of the vaccine, and you will have to pay the cost up front. Then you will have to follow your Part D plan’s rules to get a refund. Know that your doctor has no limit in how much they can change you for the vaccine, but your Part D plan will only pay its approved amount for payment. You will be responsible for the difference between the doctor’s charge and the plan’s approved payment amount.
If you have Extra Help, the federal benefit that helps people with low incomes pay for their prescription drugs, you can go to any doctor or in-network pharmacy for a vaccine. You will be covered for the vaccination and will only be responsible for the Extra Help copay.
-Marci
Medicare Reminder
It is very important that you review your drug plan every year. Medicare private drug plans can change their costs and the list of drugs that they cover every year. Most people can only change Medicare drug plans during Fall Open Enrollment (sometimes called the Annual Coordinated Election Period), which runs from October 15 to December 7 each year.
Even if you are satisfied with your current Medicare coverage, you should check if there is another plan in your area that offers better coverage at a lower price. Look at other Medicare options in your area and compare them with your present coverage to see which plan will best suit your needs in the upcoming year. Research shows that people with Part D plans could lower their costs by shopping among plans each year. For example, another Part D plan in your area may cover the drugs you take with fewer restrictions and charge you less.
When choosing a Medicare private drug plan, make sure to look at all the costs, not just the premium. Your costs throughout the year will depend on what drugs you take, whether your plan covers them, and whether there are any coverage restrictions. Another plan may have lower copays, cover more of your drugs, have fewer restrictions or offer some coverage during the coverage gap.
If you are considering joining a Medicare Advantage plan to get drug coverage, remember that you will get all of your Medicare benefits from that plan. Look beyond the drug coverage; make sure the plan covers you to go to the doctors, hospitals and pharmacies you prefer to use at a cost you can afford.
Click here to read more about reviewing your choice of Part D coverage.
Dear Marci,
Dear Marci,
I received a notice a few weeks ago in the mail from my prescription drug plan. It said that my monthly premiums were going to go up in 2015, and that some of the drugs that the plan covers are going to change. Should I consider switching my Part D plan during Fall Open Enrollment?
– Helen (Reno, NV)
Dear Helen,
Yes, during Fall Open Enrollment, you should reassess your Part D coverage and consider changing plans if your current plan will no longer meet your needs next year. Even if you are happy with your plan, it is very important to reexamine your Part D coverage each year during Fall Open Enrollment, as plans typically change their costs and list of covered drugs, known as a formulary, at the start of each year. Most people can only make changes to their Part D coverage during Fall Open Enrollment, so it is essential that beneficiaries use this opportunity to decide on their prescription drug coverage for the following year. Remember, Fall Open Enrollment takes place from October 15 to December 7 every year.
Each year, consider that there are two ways that you can get Medicare drug coverage. If you have Original Medicare, you must purchase a stand-alone Part D plan. If you have a Medicare Advantage plan, these plans often include prescription drug benefits as part of their plan’s benefits. The guidelines below can help people determine the best Part D coverage for them next year whether they have a stand-alone Part D plan or a Medicare Advantage plans with prescription drug benefits. As a reminder, you can change stand-alone Part D plans, Medicare Advantage plans or switch between Original Medicare with a stand-alone Part D plan and Medicare Advantage every year.
Before you start your research, make a list of the medications that you take on a regular basis, the dosage, and how much you pay for them. Also make a list of the pharmacies that you use regularly.
To review your Part D coverage, read your plan’s Annual Notice of Change (ANOC). Each fall, your Part D plan and/or your Medicare Advantage plan will send the ANOC to notify you of any changes for the following year. You should have received this notice by September 30th. If you did not receive it, call your plan to ask for it. Read your ANOC carefully to see whether your drugs will be covered next year. If you are unsure after reading the ANOC if the drugs you take will be covered next year, you can also call your plan to ask a representative. If your drug is not listed on your ANOC, do not assume it is covered next year. Instead, call your plan to ask. During the call, find out whether your monthly premiums orcopays will change, and if the plan is adding or changing any coverage restrictions. For example, your doctor may need to ask special permission of your plan for a drug before the plan will cover it.
Also know that if your doctor asked your plan to make a special request—like prior authorization or an exception request—to cover a specific drug for you for this year, you should take steps to make sure the plan continues to cover your drug. Your doctor may have to make a new request for the next calendar year.
If your plan will no longer cover a drug that you take, you should consider enrolling in a new plan that does during Fall Open Enrollment. If you’d like to remain in your current plan, your plan must help you complete the exception process or change to another drug formulary by the end of the year. If the plan fails to do this, your plan must provide you a 30-day supply of the drug during the first 90 days of the year, and send you a notice explaining that the prescription is temporary and that you must file an exception to continue taking it. You may want to consider switching plans during Fall Open Enrollment if your current plan will no longer cover a drug you need next year.
Once you review your coverage, you can compare it with other plan options to find one that works best for your health needs.
You can call 800-Medicare to get a list of plans in your area, or use Medicare’s online Plan Finder tool atwww.medicare.gov/find-a-plan to compare plans in your area. Click here for more information about reviewing Part D plans.
It is best to enroll in a new plan by calling 800-Medicare, as this will protect you if there are any problems with enrollment. Write down the name and employee identification number of the Medicare representative you speak with. You will be automatically disenrolled from your old plan once your new coverage goes into effect. Any changes made during Fall Open Enrollment will go into effect January 1, 2015.
-Marci
Medicare Reminder
If you qualify for Medicare-covered home health care, your Medicare home health care benefit will include the following services, if necessary:
– A limited amount of skilled nursing services and home health services, such as injections (and teaching patients to self-inject), tube feedings, catheter changes, and wound care.
– A limited amount of home health aide care if you also require skilled services. A home health aide provides personal care services including help with bathing, using the toilet, and dressing.
– Physical, speech and occupational therapy services
– Medical social services to help you with social and emotional concerns you have related to your illness.
– Certain medical supplies
– Durable medical equipment
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