You Don’t Have To, But…

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.

New Medicare Changes in Your Mailbox

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 Recipients: Potential Drug Savings for Part D Plan Members

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, in 2018 one qualifies with an income below $18,210 (single), or
$24,690 (married).  Additionally, resources (excluding one’s home, cars and personal possessions) must be worth no more than $14,100 (single), or $28,150 (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.

Physical Exam or Wellness Visit? Know the Difference

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.


Turning 65 Soon and Looking Into Medicare? Here are Resources for More Information

Social Security Administration:  ssa.gov, or call 1-800-772-1213.

Centers for Medicare and Medicaid Services (CMS):  medicare.gov or call 1-800-633-4227.  The medicare.gov website has a resource locator to help you find a doctor, compare hospitals, check coverage, get information on Medicare coverage, and compare Medicare options and plans.  The “Medicare and You” handbook is also available on this site.

State Health Insurance Assistance Programs:  each state has such a program, which provides trained counselors to help on all Medicare and Medicaid issues.  This service is free.  To locate your SHIP office, call 1-800-677-1116 or go to shiptalk.org.

Turning 65 Soon and Enrolling in Medicare? A Medicare Advantage Plan May Be an Option

Medicare is well known for its “traditional” Medicare options – the Parts A and B, and a few years ago the Part D Prescription Plan option. But there is one more part, a “Part C,” the Medicare Advantage Plans. Not often heard about, it is an option that is available to anyone in traditional Medicare, and for some, it can be a viable option. Here is a bit on what you need to know:

Provided through local or regional private plans, Part C Medicare Advantage Plans must include everything traditional Medicare covers. These plans may provide more benefits, and most of them offer the Part D prescription plan as part of the plan coverage. There is usually a monthly premium amount, which would be in addition to the Part B premium. The plans might offer more benefits and lower co-pays than traditional Medicare. Some plans may have restrictions on doctors and other providers, requiring you to see only in-network providers in order for services to be covered. Plans have limits on out of pocket costs. Finally, plans can change premiums, benefits and co-pays on an annual basis. To learn more about Medicare Advantage plans, and compare the plans offered in your area, go to www.medicare.gov, or contact the Medicare help line at 1-800-633-4227.