Wednesday, November 12, 2014

A "MUST READ" for those considering Medicare Options. Call me with Questions 917/406-8714


Credit Robert Neubecker       
For millions of older Americans, it is time to sift through the mind-boggling array of Medicare plans.
There is an average of 29 drug plans to digest, and about 18 options for Medicare Advantage, the plans delivered through private insurers. Then there are the 10 supplemental plans that cover what traditional Medicare does not.
The choices can be paralyzing for anyone, and they can be even more challenging as you age. The Medicare open enrollment season, which runs from Oct. 15 through Dec. 7, gives individuals a chance to rethink it all and reassess whether their plan still fits their needs.
While no broad-based changes are expected, there could be meaningful shifts within individual plans. Maybe your Part D prescription plan will no longer pay for one of your drugs, or you started a new one. Perhaps your Medicare Advantage plan dropped your favorite doctor (or worse, a cancer treatment center) from network.

“People treat this as a momentous decision but they get scared of it, and the thing that worries me is that they don’t make the changes that they should,” said Joe Baker, president of the Medicare Rights Center in New York. “Don’t stay in a plan because you’re overwhelmed with the choices.”
   

Elizabeth Cooper of Birmingham, Ala., has a history of skin cancer. She changed her plan because she worried about unanticipated medical costs. Credit Gary Tramontina for The New York Times

Elizabeth Cooper, a 68-year-old former elementary schoolteacher, weighs her options each year. She has already tried a couple of plans, including one through Medicare Advantage, which lured her in because it had no monthly premium. But the plan required her to shoulder a significant share of her medical costs.
 
She is healthy now, but she has a history of skin cancer. “I didn’t feel that would give me a sense of ease because of the co-pays and the possible unexpected expenses that can crop up,” said Ms. Cooper, of Birmingham, Ala.
 
So she backed out of that plan during the trial period, and opted for peace of mind. She enrolled in original Medicare, and bought a supplemental policy for about $135 a month that covers items like deductibles and her share of each bill. After having a few diagnostic tests this year, her decision already paid off.
 
“Had I been on the Advantage plan, I would have had to come up with the money for each test,” she said. “It turned out to be a reasonable plan for me. And for that reason, I plan to stick with it.”
Here are some ideas on how to approach the decision-making process.
 
A REFRESHER COURSE Before delving into the details, here is a quick primer on original Medicare: Part A covers hospital and skilled nursing facility stays, as well as some home health visits and hospice care. Part B covers preventive care, doctor visits and outpatient services. Premiums, for most retirees, were $104.90 a month last year and are projected to be the same in 2015.
Deductibles, co-payments and coinsurance (that is when you pay for a percentage of medical services) can be burdensome since there is no out-of-pocket ceiling, experts said. That is one of the reasons most people buy supplemental coverage, known as Medigap, to cover out-of-pocket costs on Parts A and B. People lucky enough to have retiree employer coverage rely on that instead.
Medicare Part D, which is offered only through private insurers, covers drugs. The average monthly premium for such plans is estimated at $32 in 2015, according to the Centers for Medicare and Medicaid Services.
 
Alternatively, you can just buy a Medicare Advantage plan from a private insurer, also referred to as Part C. It can serve as a one-stop shop because it covers Parts A, B and often a drug plan — and sometimes throws in extras like dental and vision coverage. Average monthly premiums for Advantage plans are estimated to rise to $33.90, a $2.94 increase, in 2015, according to the Centers for Medicare and Medicaid Services. (aYou pay that in addition to the Part B premium).
ORIGINAL OR ADVANTAGE? Some consumer advocates favor using traditional Medicare with a supplemental plan, largely because it is more predictable and you are free to see any doctor who accepts Medicare.
That is what Mr. Baker said he would recommend for his own grandmother. “I would say enroll in original Medicare and let’s get you the Medigap plan you might need when you are older or sicker,” he said. “If you are in original Medicare and you have a Medigap plan, you are pretty much set for life if you are happy with those things.”

Medigap, with 10 plan levels that are labeled with letters from A to N, is federally standardized coverage, which means coverage must be exactly the same across insurers. For instance, the option known as Plan F will pay for your Part A and Part B deductibles. “This is one area, once you decide on the level of coverage you want, where you can go for the lowest price because you know Plan F will be exactly like any other Plan F,” said Jocelyne Watrous, advocate at the for the Center for Medicare Advocacy.
 
Depending on the plan, the total cost of your premiums could come close to your final out-of-pocket cost for the year. In Connecticut, for instance, one of the most comprehensive Medigap policies is called Plan F. It costs an individual about $218 a month, or $2,622 annually. “But that’s it,” Ms. Watrous said. “You will pay that premium and it will cover all of your co-payments and deductibles.”
If you are contemplating switching from Medicare Advantage back to original Medicare — and you want to buy a supplemental policy — that is something you may want to do while you are younger and healthier. Later on, coverage may become more expensive or you can be denied altogether. With some exceptions, individuals are guaranteed coverage only if they buy it during a special period six months after their 65th birthday. During that time, insurers cannot refuse to sell you a policy because of a pre-existing condition or other medical issue, nor can they charge you more.
 
ADVANTAGE Nearly 16 million people, or 30 percent of all Medicare beneficiaries, enroll in a Medicare Advantage plan. Most people are attracted by the plans’ enticingly low and sometimes zero premiums and, for certain services, low co-payments. Some even offer limited dental or vision coverage, advocates said.

The drawback of Advantage plans are their limited networks of providers. Doctors can drop out midyear. And consumers are responsible for all cost-sharing, which can be unpredictable. Those are capped at an out-of-pocket limit for in-network services of $6,700 in 2015, although the Center for Medicare and Medicaid Services recommends a limit of $3,400, according to Kaiser.
But it is difficult to calculate how fast you might reach those ceilings. “The cost-sharing requirements are often harder to compare because it requires consumers to anticipate what their health care needs might be,” said Tricia Neuman, director of the Medicare policy program at Kaiser. “Some advisers suggest considering what services you would need if you were sick and take a careful look at potential costs under various plans.”
 
People who travel frequently or who spend a significant chunk of time in another state also need to ensure that they will be covered. “Snowbirds need to consider whether the networks and coverage extends to two places,” said Nicole Duritz, vice president for health, education and outreach at AARP.
 
If you are already enrolled, the “annual notice of change” sent to plan enrollees will detail changes in coverage, costs and networks. But if you are dissatisfied with your Advantage plan for any reason, you can unenroll from Jan. 1 to Feb. 14 and switch to original Medicare.
 
DRUGS Even if you are happy with your Part D coverage, don’t assume it will remain exactly the same. Lists of covered drugs often change or the company may insert new restrictions, limiting quantities or requiring you to try another drug first.
 
Go to the Medicare website’s Plan Finder, where you can enter your drugs, the dosage and frequency, as well as where you like to buy them. It will then show you what the plans cover and your total estimated costs for the year. “The plans are so complicated and there is so much variation and the only way to really compare is to use the Plan Finder,” Ms. Watrous said.
Don’t shop on price alone. “The best and cheapest plan for you is the one that covers your drugs the best,” said Mr. Baker, who advised calling the plan, or even your doctor or pharmacist, who has a lot of interaction with the different plans.
 
RESOURCES Besides local SHIP agencies, advocates suggest that people check out the latest Medicare & You booklet, which all 54 million enrollees should have received in the mail by now. It’s remarkably clear. To talk to someone live, call 1-800-Medicare. Whatever you do, Mr. Baker advised, “Don’t renew blindly.”

Friday, May 23, 2014

Finally a Seriously Decent Dental Plan for Individuals, Sole Props & Small Biz

   USA+ Ameritas DENTAL CARE Insurance 

UPDATE 2015 - AMERITAS DENTAL CARE PLAN NO LONGER AVAILABLE IN NY STATE. I CAN HELP MY CLIENTS WITH THIS PLAN IN PA, NJ, CONN & GA.

               Call or email and I can tell you all about it. Robin Alexander-917.406.8714                                                       Robin@RobinAlexander.com


Sold under the name USA+ Ameritas Group (United Service Association). You receive the benefits and costs of large group coverage as an individual. (Think AAA or Union Plans)

Check out this video for a quick overview:  http://player.vimeo.com/video/82391754

How does this plan stack up against the popular AARP Dental Plan? See for yourself

PLAN BENEFIT DESCRIPTION
AARP - PPO Plan B
Monthly Premium 
Individual:  $47.76

2 people    $93.97

3 + $133.53
AARP - PPO Plan A
Monthly Premium 
Individual:  $67.51

2 people:  $133.44

3 +$202.90
AMERITAS DENTALCARE
1st Year
Monthly Premium 
Individual:  $69.00

2 people   
$99.00

3 + $139.00
AMERITAS DENTALCARE
2nd , 3rd, 4th Year, etc
Monthly Premium 
Indiv:  $69.00

2 people    $99.00

3 + $139.00
Deductible per calendar year per person
$100
$50, waived on Diagnostic and Preventive
$70
$70
Maximum per calendar year per person
$1,000
$1,500
$2,500
2nd Yr: $2,900*
3rd Yr: $3,300*
4th Yr: $3,900*
You Pay
You Pay
You Pay
You Pay
Office visit
20%
0%
20%
0%
Exams
20%, 3 per Calendar Year
0%, 3 per Cal Year
20%
0%
X-rays
20%
0%
40%
0%
Cleanings
20%, 3 per Calendar Year
0%, 3 per Cal Year
20%
0%
Fillings
50%
50%
75%
25%
Root canals   (Endontic Services)
50%
50%
90%
60%
Gum treatment (Periodontic Services)
50%
50%
90%
60%
Extractions       (Oral Surgery)
50%
50%
75%
25%
Denture repair
50%
20%
75%
25%
Crowns
50%
50%
90%
60%
Orthodontics
Not a covered benefit
Not a covered benefit
Not a covered benefit
Not a covered benefit

*AMERITAS DENTALCARE has a “Reward” program for members who take care of their teeth and use a portion of their annual maximum benefits. With this increasing maximum feature, each member/dependent earns additional money towards their next  year annual max all the way up to year 4. Here’s how it works:                                                                                                                               1) Visit your Dentist during the year.
2) Submit claim for payment prior to April 1st                                                                                                 3) Total benefits paid for current year visits musrent year visits must be less than  $750
* If you meet all 3 requirements you will have an additional $400 available in Annual Maximum for the next year.                                                                                            
** In future years, if you have benefits paid of less than $750, additional amounts of $400 will be added to  the carryover amount.                                                    
***Your annual maximum caps out at $3700 in four years just for visiting the dentist at least once a year and having no more than $750 of work done.       
THIS PLAN HAS AN "ALL DENTIST NETWORK" ANY DENTIST WILL OFFER REDUCED FEES. GO TO AN AMERITAS DENTIST (65,000 DENTISTS IN THE NETWORK) AND SAVE SIGNIFICANTLY MORE 
              Call or email and I can tell you all about it. Robin Alexander-917.406.8714                                                       Robin@RobinAlexander.com  


My Advocate helps you find healthcare programs and savings which you deserve. Sign up today for free.

https://www.myadvocatehelps.com/

My Advocate

formerly Social Service Coordinators, is a set of three different programs designed to assist members with health care costs and other potential financial and social challenges: Low Income Subsidy (LIS), Medicare Savings Program, and Golden Touch.
  • Low Income Subsidy (LIS) is available for Part D premium, Part D deductible, Part D  copayments.
  • The Medicare Savings Program (MSP) is similar to state Medicaid and covers Part B premium ($104.90/month in 2014), Part B deductible ($147 in 2014) and Parts A and B cost sharing.
  • Golden Touch is a collection of financial assistance and other community-based programs. Golden Touch Advocates have access to over 7,000 different national and local programs to offer individuals.
As a Licensed, certified Medicare Product Specialist, I can help members and consumers understand if My Advocate is a good fit for their needs. Many Americans are eligible for, but not enrolled into, social service programs that can improve quality of life and lower cost of care. Members and consumers might not know that they are eligible for My Advocate, which may offer valuable assistance in their health care needs. This is where I come in – as your agent I can help you learn more and understand if the My Advocate Program is a good fit.
 
Talk to you soon!
 
Robin Alexander
Licensed Medicare Agent
9701 Shore Road | Suite 1C | Brooklyn, NY 11209
p. 917.406.8714 | f. 718.374.5358
email: robin@robinalexander.com
http://robinalexandermedicare.blogspot.com/

The greatest compliment you can give me is a referral.
Please feel free to pass along my contact information!
 
 
 
 

Sunday, April 20, 2014

Health Care Nightmares

APRIL 10, 2014
NYT OP-ED
 
 
When it comes to health reform, Republicans suffer from delusions of disaster. They know, just know, that the Affordable Care Act is doomed to utter failure, so failure is what they see, never mind the facts on the ground.
Thus, on Tuesday, Mitch McConnell, the Senate minority leader, dismissed the push for pay equity as an attempt to “change the subject from the nightmare of Obamacare”; on the same day, the nonpartisan RAND Corporation released a study estimating “a net gain of 9.3 million in the number of American adults with health insurance coverage from September 2013 to mid-March 2014.” Some nightmare. And the overall gain, including children and those who signed up during the late-March enrollment surge, must be considerably larger.
But while Obamacare is looking like anything but a nightmare, there are indeed some nightmarish things happening on the health care front. For it turns out that there’s a startling ugliness of spirit abroad in modern America — and health reform has brought that ugliness out into the open.
Let’s start with the good news about reform, which keeps coming in. First, there was the amazing come-from-behind surge in enrollments. Then there were a series of surveys — from Gallup, the Urban Institute, and RAND — all suggesting large gains in coverage. Taken individually, any one of these indicators might be dismissed as an outlier, but taken together they paint an unmistakable picture of major progress.
But wait: What about all the people who lost their policies thanks to Obamacare? The answer is that this looks more than ever like a relatively small issue hyped by right-wing propaganda. RAND finds that fewer than a million people who previously had individual insurance became uninsured — and many of those transitions, one guesses, had nothing to do with Obamacare. It’s worth noting that, so far, not one of the supposed horror stories touted in Koch-backed anti-reform advertisements has stood up to scrutiny, suggesting that real horror stories are rare.
It will be months before we have a full picture, but it’s clear that the number of uninsured Americans has already dropped significantly — not least in Mr. McConnell’s home state. It appears that around 40 percent of Kentucky’s uninsured population has already gained coverage, and we can expect a lot more people to sign up next year.
Republicans clearly have no idea how to respond to these developments. They can’t offer any real alternative to Obamacare, because you can’t achieve the good stuff in the Affordable Care Act, like coverage for people with pre-existing medical conditions, without also including the stuff they hate, the requirement that everyone buy insurance and the subsidies that make that requirement possible. Their political strategy has been to talk vaguely about replacing reform while waiting for its inevitable collapse. And what if reform doesn’t collapse? They have no idea what to do.
At the state level, however, Republican governors and legislators are still in a position to block the act’s expansion of Medicaid, denying health care to millions of vulnerable Americans. And they have seized that opportunity with gusto: Most Republican-controlled states, totaling half the nation, have rejected Medicaid expansion. And it shows. The number of uninsured Americans is dropping much faster in states accepting Medicaid expansion than in states rejecting it.
What’s amazing about this wave of rejection is that it appears to be motivated by pure spite. The federal government is prepared to pay for Medicaid expansion, so it would cost the states nothing, and would, in fact, provide an inflow of dollars. The health economist Jonathan Gruber, one of the principal architects of health reform — and normally a very mild-mannered guy — recently summed it up: The Medicaid-rejection states “are willing to sacrifice billions of dollars of injections into their economy in order to punish poor people. It really is just almost awesome in its evilness.” Indeed.
And while supposed Obamacare horror stories keep on turning out to be false, it’s already quite easy to find examples of people who died because their states refused to expand Medicaid. According to one recent study, the death toll from Medicaid rejection is likely to run between 7,000 and 17,000 Americans each year.
But nobody expects to see a lot of prominent Republicans declaring that rejecting Medicaid expansion is wrong, that caring for Americans in need is more important than scoring political points against the Obama administration. As I said, there’s an extraordinary ugliness of spirit abroad in today’s America, which health reform has brought out into the open.
And that revelation, not reform itself — which is going pretty well — is the real Obamacare nightmare.
 
 

Monday, March 24, 2014

Still Smoking? Read this - there's help out there with Medicare.

Health Tip
According to a Morbidity and Mortality Weekly Report released by the Centers for Disease Control and Prevention (CDC) earlier this year, the rate of new lung cancer cases in the United States decreased from 2005 to 2009. Specifically, the study found that new rates of lung cancer went down 2.6 percent each year among men, and 1.1 percent each year among women. The study also found that the fastest drop in new lung cancer rates occurred among adults ages 35-44 years old. The study used data from the used 2005-2009 data from the National Program of Cancer Registries and the National Cancer Institute’s Surveillance, Epidemiology, and End Results program.

According to the report’s press release, smoking continues to be the leading cause of preventable death and disease in the United States. The press release quotes CDC Director, Dr. Tom Frieden, who said that “while it is encouraging that lung cancer incidence rates are dropping in the United States, one preventable cancer is one too many.” He goes on to say, “Implementation of tobacco control strategies is needed to reduce smoking prevalence and the lung cancer it causes among men and women.”

In general, Medicare covers two counseling attempts each year to help you quit smoking. Each attempt includes four sessions, meaning Medicare covers a total of eight counseling sessions every 12 months to help you quit smoking. Click here to read more about Medicare coverage of counseling sessions to help you quit smoking. Click here to read the entire press release on the CDC report.

Medicare Drug Restriction? Don't take "No" for an answer.

Mailbox
Volume 13 Issue 6 • March 24, 2014
 

What is a coverage restriction?



 
Dear Marci,

I went to the pharmacy to pick up a new medication, but my pharmacist told me that there is a coverage restriction on the drug I need. What is a coverage restriction? 

- Chuck (Staten Island, NY)
Dear Chuck,

A coverage restriction is a restriction that Medicare prescription drug plans, also known as Medicare Part D plans, place on certain covered drugs to limit use of that drug. In other words, while a drug may be covered by your Part D plan, your plan may not pay for a drug you need if it has a coverage restriction.There are three types of coverage restrictions:

  • Prior authorization is a type of coverage restriction that requires you to get prior approval from your Part D plan, before your plan will pay for a prescription drug you need. 
  • Quantity limit is a type of coverage restriction that limits you to a specific amount of a medication over a certain period of time. For example, let’s say your Part D plan only covers 30 pills of Drug X in one month. If you need 40 pills of Drug X in one month, your prescription may be denied. As such, you will most likely need to request that your Part D plan make an exception to its quantity limit.
     
  • Step therapy is a type of coverage restriction that requires you to try other, usually cheaper drugs that treat your medical condition, before your Part D plan will cover the drug that your doctor originally prescribed.
If you aren’t able to get your drug at the pharmacy because of a coverage restriction, your pharmacist should give you a notice called, Medicare Prescription Drug Coverage and Your Rights. This is a notice that explains the process of contacting your Part D plan to request coverage of the drug you need. Keep in mind that this is simply an educational notice that provides you with very general information on the first steps of the appeal process. This is important to know, since you generally need to receive a written, formal denial notice from your Part D plan in order to begin the appeal process. The Medicare Prescription Drug Coverage and Your Rights notice is not a formal denial from your Part D plan. However, you should still read it for your own understanding.

If your pharmacist told you that your Medicare Part D plan will not cover the drug you need, you should contact your Part D plan directly. It’s helpful to do this to find out why your Part D plan is not covering the drug you need. If the denial is due to an administrative error, it should be resolved when you call your plan. Remember to write down the date and time in which you call, the name of the Part D plan agent you speak to, and the outcome of your call.

If your Part D plan is denying your drug because of a coverage restriction, contact your doctor to see if another unrestricted drug covered by your Part D plan will work for you. If your doctor cannot prescribe a different drug, ask your doctor to help you file a formal request to your Part D plan so that you can try to override the coverage restriction. This is called filing an exception request. It may also be referred to as filing a coverage determination. Filing an exception request with your Part D plan is the step you take before you can file an appeal. While plans generally provide decisions on exception requests within 72 hours, you and your doctor can request that your plan make a quicker (expedited) decision to your exception request in 24 hours if your health would be harmed by waiting the standard 72 hours for a plan decision.

Keep in mind that you can file an exception request with your Medicare Part D plan, whether you get Medicare Part D through a stand-alone Part D plan that works with Original Medicare or through a Medicare Advantage Prescription Drug Plan, also known as a Medicare private health plan that provides you with Medicare prescription drug coverage
Click here to use a Medicare Interactive Roadmap that can help walk you through the necessary steps of appealing a Part D drug denial. Click here for information on the Medicare Part D appeal process.

-Marci
Health Tip
According to a Morbidity and Mortality Weekly Report released by the Centers for Disease Control and Prevention (CDC) earlier this year, the rate of new lung cancer cases in the United States decreased from 2005 to 2009. Specifically, the study found that new rates of lung cancer went down 2.6 percent each year among men, and 1.1 percent each year among women. The study also found that the fastest drop in new lung cancer rates occurred among adults ages 35-44 years old. The study used data from the used 2005-2009 data from the National Program of Cancer Registries and the National Cancer Institute’s Surveillance, Epidemiology, and End Results program.

According to the report’s press release, smoking continues to be the leading cause of preventable death and disease in the United States. The press release quotes CDC Director, Dr. Tom Frieden, who said that “while it is encouraging that lung cancer incidence rates are dropping in the United States, one preventable cancer is one too many.” He goes on to say, “Implementation of tobacco control strategies is needed to reduce smoking prevalence and the lung cancer it causes among men and women.”

In general, Medicare covers two counseling attempts each year to help you quit smoking. Each attempt includes four sessions, meaning Medicare covers a total of eight counseling sessions every 12 months to help you quit smoking. Click here to read more about Medicare coverage of counseling sessions to help you quit smoking. Click here to read the entire press release on the CDC report.
Need to Know
Medicare Interactive, a online resource developed and maintained by the Medicare Rights Center, can help you find easy-to-understand answers to your Medicare questions. Check out Medicare Interactive’s newly redesigned appeals section. The appeals section reviews how to appeal any Medicare health or drug denial. Remember, you have the right to appeal if you disagree with Medicare or your plan’s coverage decision on a health care service or item you need. 
For reprint rights, please contact Mitchell Clark.
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Contents are © 2014 by Medicare Rights Center, 520 Eighth Avenue, North Wing, 3rd Floor, New York, NY

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