In the work I do with people who receive VA benefits and are also eligible for Medicare Part B, I am often asked if they should enroll in Part B. “After all, it costs $99.90 a month (current rate), and if I have VA healthcare benefits and use the VA hospital system, do I really need it?” I am asked.
And the answer is, “No, you don’t have to, but” (and this is where the list starts):
- If you ever use medical services outside the VA system, Medicare Part B will help you cover those costs. VA covers services within the VA system.
- Delaying your initial enrollment for Medicare Part B can cost you in penalties. Monthly premiums increase 10 percent for each 12-month period a person is eligible but did not enroll. The longer one waits, the higher the premium gets.
- If the monthly premium for Medicare Part B is beyond your budget, you might want to look into your state’s Medicare Savings Program.
Two good phone numbers to have are Social Security: 1-800-772-1213, and VA Health Benefits: 1-877-222-8387. Representatives at these numbers can be very helpful in sorting through these questions.
Not a month goes by that I don’t have someone handing me a copy of their Medicare Summary Notice and asking me to help them decipher what it says. Needless to say, it is long, complicated and confusing. Often, the question I get is “Do I owe them any money?” While these notices are just notices, and not bills, I get concerned that people choose not to review them. I always remind people that getting these notices is a good chance to review the information to be sure it records procedures and physician appointments that actually happened. For some, I am the one who reviews the information to be sure of accurate billing. At least twice in the last year I discovered inaccurate billing. In these cases they did not amount to a different dollar amount, but it was still important to call and inform Medicare of the errors.
Now, in an effort to make the notice more consumer-friendly, and encourage members to review each notice to catch errors or possible fraud, Medicare has revised the notice, and beginning next year, will start using the new and improved notice for their 36 million beneficiaries. The new consumer-friendly format can be viewed at Medicare Summary Notice. Still long, especially for those with chronic health problems and frequent medical appointments, it should be easier to review and understand, and thereby identify and report any fraudulent activity.
Medicare has a program called “Extra Help” that can be a big savings for those who qualify. Medicare officials are estimating that approximately two million people qualify but have not applied. In order to get the benefit, one must apply. If eligible, the prescription savings can be significant.
Under the Extra help program, one qualifies with an income below $16,335 (single), or
$22,065 (married). Additionally, resources (excluding one’s home, cars and personal possessions) must be worth no more than $12,640 (single), or $25,260 (married).
Once enrolled, the savings are in the premiums, deductibles and low copayments for
drugs. If you know someone struggling with the cost of their medications, qualify on income, and they are enrolled in a Medicare Part D prescription plan, they can enroll online at the Social Security Website or call 1-800-772-1213.
As a Geriatric Care Manager and Elder Care Consultant, I am often asked to help sort through the details of Medicare coverage. There are so many things to know and to understand: Parts A & B, Medicare Advantage (Part C) and Part D for prescription coverage. Earlier in 2011 we began to see the changes under the new health care law. One of those changes turns out to have been a little confusing. Here is why:
Beginning in 2011, Medicare started covering an annual physical exam, or so many thought. But, as it happens, it wasn’t really a physical exam in the true sense. What Medicare started covering is a “Wellness Visit,” which is definitely different than a physical exam.
The 2011 Medicare Handbook “Medicare and You 2011” labeled it a “physical exam.” Logically, many Medicare recipients expected a physical exam. But a wellness visit is less a physical exam and more of a discussion between a doctor and patient, reviewing a patient’s health status and medical risk factors. The discussion may lead to referrals to specialists or for further tests.
Because of the misleading information in the 2011 handbook, the 2012 handbook is being updated to reflect the true “Wellness Visit.” It is also recommended that Medicare recipients specifically request a “wellness visit,” if that is what they are seeking. It is an annual wellness visit that Medicare will cover. A physical exam is altogether different, and coverage for it is as well.
Kathleen S. Allen, LCSW, LICSW, C-ASWCM, is a Geriatric Care Manager and Elder Care Consultant in the Washington D.C. metropolitan area. She works with seniors and their families, and with organizations and their employees or members to help guide them through the challenges of aging and caregiving.
Medicare Open Enrollment is upon us, and for those with Parts C (Medicare Advantage) or Part D (Prescription Coverage), this is the time to review your current plan for changes, and if necessary, find an alternative that fits your medical and financial needs.
Some good news this year is that the premiums for Part D plans are holding steady, and the 50% brand drug discount will continue through 2012. There will also be a 14%
generic drug discount in 2012. That means that when you are in the coverage gap for your medications, and you need to buy a brand name drug, the cost to you will only be 50% of the total cost, but the full cost of the drug will count toward your total out of pocket
expense. Similarly, generic drugs will have a 14% discount during the coverage gap in 2012 but the total cost will apply toward your out of pocket costs.
When we talk of Part D plans, out of pocket expenses, and premiums and deductibles, it is easy to get confused. An excellent online resource for calculating out of pocket prescription expenses can be found at Q1Medicare. If you plug your drug costs in, it will calculate when you reach the coverage gap (also known as the “doughnut hole”), when you exit, and estimate your total out of pocket expenses for the year. A picture is worth a thousand words, as they say, and the table that shows on the calculator sometimes explains things far more effectively than an article explanation.
A word to the wise: Please proceed with this process earlier rather than later. Past years have shown that the Medicare phone lines get very busy in the final days and the website can slow down when so many people are on it at once.