Articles Posted in Medicare

7.21.17You must sign up for Medicare Part B no later than eight months after retirement, or the penalties could be serious.

These are the details that really matter when it comes to retirement and Medicare. If you signed up for Medicare Part A on your 65th birthday but were still working, you probably didn’t enroll in Part B. Now you’ve just turned 68 and plan on retiring this year. When do you need to enroll in Medicare Part B, and what do you need to know to ensure that you’re covered?

Kiplinger’s recent article, “What to Know About Enrolling in Medicare Part B,” says that many people who are still working do this. They sign up for Medicare Part A at 65 (because it’s free) and wait to sign up for Part B, while they’re covered by their employer’s insurance. However, you are required to sign up for Medicare Part B no later than eight months after you leave your employment and lose that coverage. Failure to do so, can result in a lifetime penalty and a gap in coverage.

4.25.17Even if you are still working, once you turn 65, you have to navigate your way through an entirely new and complex health care system. While there’s no HR department, there are resources.

It starts the day you turn 65, and it’s a bit of a challenge. Seniors need to get up to speed fast on the many requirements of Medicare. A recent post of Kiplinger’s, “FAQs About Medicare,” warns that mistakes can be extremely costly and difficult to fix. You’ll want to study up on this in advance.

For starters, if you signed up for Social Security before age 65, you’ll automatically be enrolled in Medicare parts A and B and receive your card three months before your 65th birthday. Part A covers hospitalization and is generally premium-free. Part B covers outpatient care, such as doctors’ visits, x-rays and tests, and costs $134 a month for people who enroll in 2017 (or more for high earners).

2.8.17You might think that any doctor seeing patients over a certain age would automatically screen for Alzheimer’s or other dementia-related diseases, but until now that has not been the case.

Starting in January, Medicare will now begin reimbursing doctors for screening and providing information about care planning for patients with Alzheimer’s and other cognitive impairment diseases. What seems like common sense public health policy, took many years of advocacy from patient groups.

Santa Cruz Sentinel’s recent article, “Diagnosing Alzheimer’s: Medicare now pays doctors to stop and assess memory loss,” reports that more than 5 million Americans are living with Alzheimer’s, and as many as 16 million will have the disease in 2050.  The cost of caring for those with the disease and other types of dementia is also skyrocketing. In the U.S., it’s estimated to total $236 billion in 2016 and is anticipated to increase to $1.1 trillion by 2050.

8.15.16The cost of long-term care can take a huge bite out of retirement savings, exhaust family resources and create strain on relationships. Don’t count on Medicare, but do plan in advance.

At least seven out of ten Americans age 65 and over will need long-term care at some point. Most people simply underestimate the cost of long-term care, or they think that Medicaid will cover the costs. Your best defense against long-term care costs: advance planning with professional help.

The Memphis Daily News article, “Long-Term Care – Not for Everyone,” says that Medicare does little for these costs and only for a short time period. Medicaid doesn’t apply until the assets of an estate are spent down, so many people must pay for these costs out-of-pocket. The article says that there are only two ways to address these expenses: with your investment/retirement portfolio and with long-term care insurance. Most people review the cost of long-term care insurance and elect to roll the dice, but when that first round of expenses hits, they probably will wish they’d bought it long ago. Now it’s usually too late to buy it. If you can afford to self-insure, you can save your estate and yourself some serious money.

Nursing homes that give substandard care to residents are the target of new Elder Justice Task Forces intended to move faster in targeting and penalizing certain facilities.

5.27.16The National Review reports in "DOJ Task Forces Target Elder Fraud in Health Care" that teams from several Elder Justice Task Forces deployed by the U.S. Department of Justice will go after heath care providers who commit crimes against residents and patients, most of whom are elderly and vulnerable.

The Elder Justice Task Forces have a goal of coordinated, joint investigations to allow for quicker enforcement actions and prosecutions. These Task Forces combine federal, state, and local resources from law enforcement, the U.S. Department of Health and Human Services, state adult protective services agencies, long-term care ombudsman programs, U.S. attorneys' offices, state Medicaid fraud control units, and state and local prosecutors' offices.

Older couple with documentAs a direct result of complex relationships between Social Security and Medicare and a number of other unforeseen issues, 2016 will be an expensive year for some seniors, according to Forbes' recent article, "Untangling the Medicare Premium Mess — And What It Means For You." Medicare laws require it to increase premiums annually to cover increases in per capita costs. This would typically be about $16, which most seniors can manage.

Except that 2016 will not be a normal year. Most retirees have their Medicare premiums deducted from their Social Security benefits, but because inflation was so low this year, there won't be a cost-of-living increase in 2016 for Social Security. And the law says that if Social Security benefits don't rise—you guessed it—neither can the Medicare premiums.

That means about 70% of Medicare beneficiaries won't see the premium hike. However, that leaves the entire burden of this year's Medicare cost increases on the remaining 30%. Those guys are going to be hit with 50% premium hikes.

Bigstock-Elder-Couple-With-Bills-3557267"If you get a claim denial, always contact your doctor or hospital to see if they can help you through the appeal," said Shirley Whitenack, president of the National Academy of Elder Law Attorneys and a partner with law firm Schenck, Price, Smith & King.

Larry Tocco retired last year from a job in the collections department of a credit union. After some medical treatment, he started receiving past-due notices from health care providers after his claims on a Medicare plan weren't paid. After several frustrating phone calls, Larry learned he was still on the active employee roll of the health insurance plan covering his former employer. As a result, his Medicare plan was considered secondary coverage.

A benefits manager from the credit union told him they sent the retirement paperwork, but the representatives with the Medicare provider said they didn't get it.

MP900423013Medicare has published new rules spelling out the changes, and an education campaign aimed at healthcare providers began in January. But many healthcare providers haven't grasped it, either.

As you may know, Medicare has recently undergone a big change affecting long-term care and the availability of skilled nursing or therapy. Namely, thousands are now eligible for Medicare benefits, but you might just have to point that out to care providers.

The slow transition to full adoption of the rules and new standards of care, as well as the continuing plight of those left in a lurch, is discussed in a recent Reuters article titled “New Medicare coverage of long-term care off to a rocky start.” As pointed out there, you or a loved one may be eligible for benefits, but may need to fight to receive the benefits.

MP900423013What does this mean? Imagine you have a severe stroke. Before Jimmo, most people thought Medicare would pay for physical therapy only as long as that PT was helping you get better. For instance, Medicare would pay if therapy helped increase the number of steps you could walk without assistance. Now, Medicare will pay for PT even if it only helps you maintain your current ability to walk.

Whenever the rules for receiving Medicare benefits change it has a real impact on real beneficiaries and patients. Sometimes legal changes occur literally overnight, while at other times the changes are more subtle. After a landmark lawsuit a year ago, there may be some tangible effects to the system – for the better. This is especially the case when an elderly loved one requires skilled nursing or physical therapy.

The landmark case was Jimmo v. Sebelius. Recently, Forbes explored the legal evolution Jimmo sparked in an article titled “When Medicare Will Pay for Skilled Nursing or Physical Therapy.

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If a beneficiary disagrees with a decision, there are reconsideration and appeals procedures within the Medicare program.

Medicare approvals can be tough at times, and some may find their claims come up with the big "D" – denial. So what happens when Medicare denies a beneficiary’s claim for care?

While it is not always smooth sailing, it is important to know that you are not without recourse. You can appeal Medicare decisions to refuse coverage for needed care, and sometimes you simply must.

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