Medicare – General Informaton

Medicare – General Informaton

Medicare is a health insurance program for:

  • People age 65 or older.
  • People under age 65 with certain disabilities.
  • People of all ages with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant).

Medicare has different parts that help cover specific services:
Medicare Part A (Hospital Insurance) – Part A helps cover inpatient care in hospitals, including critical access hospitals, and skilled nursing facilities (not custodial or long-term care). It also helps cover hospice care and some home health care. Beneficiaries must meet certain conditions to get these benefits. Most people don’t pay a premium for Part A because they or a spouse already paid for it through their payroll taxes while working.

Medicare Part B (Medical Insurance) – Part B helps cover doctors’ services and outpatient care. It also covers some other medical services that Part A doesn’t cover, such as some of the services of physical and occupational therapists, and some home health care. Part B helps pay for these covered services and supplies when they are medically necessary. Most people pay a monthly premium for Part B.

Medicare Part D (Prescription Drug Coverage) – Medicare prescription drug coverage is available to everyone with Medicare. To get Medicare prescription drug coverage, people must join a plan approved by Medicare that offers Medicare drug coverage. Most people pay a monthly premium for Part D.

If you’re a person with Medicare or help a person with Medicare, visit Medicare.gov to find more information about Medicare.

7 Ways Medicare Will Improve in 2019

7 Ways Medicare Will Improve in 2019

Changes range from an early close of the donut hole to expanded Medicare Advantage plan benefits

Now 53 years old, Medicare has higher rates of satisfaction from its 60 million members than almost any other form of health insurance. It is about to get better. Here are seven improvements to Medicare that will take effect in 2019. Some of the changes will affect all beneficiaries while others will apply just to individuals who select Medicare Advantage plans.

Donut hole

An expensive element of the Medicare Part D prescription drug benefit requires enrollees with high prescription costs to pay more for their medicines after they reach a certain level of spending in one year. This creates a coverage gap – also called the “donut hole.” After a beneficiary’s out-of-pocket spending reaches a second threshold, they enter catastrophic coverage and pay substantially less. Under the Affordable Care Act (ACA), the donut hole was scheduled to close in 2020. But the spending bill Congress passed in March will close the donut hole for brand-name drugs in 2019. The gap will close for generic drugs in 2020.

Therapy cap gone

Beneficiaries of original Medicare won’t have to pay the full cost of outpatient physical, speech or occupational therapy because Congress permanently repealed the cap that has historically limited coverage of those services.

Better information

Medicare is updating the handbook it sends to beneficiaries every fall. It will include checklists and flowcharts to make it easier to decide on coverage. The online Medicare Plan Finder tool will be easier to use and an improved “coverage wizard” will help enrollees compare out-of-pocket costs and coverage options between original Medicare and Medicare Advantage.

More telemedicine

Medicare is steadily broadening the availability of telehealth programs that let patients confer with a doctor or nurse via telephone or the internet. In 2019, it will begin covering telehealth services for people with end-stage renal disease or during treatment for a stroke.

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Lifestyle support

Beginning in January, Medicare Advantage plans have the option to cover meals delivered to the home, transportation to the doctor’s office and even safety features in the home such as bathroom grab bars and wheelchair ramps. To be covered, a medical provider will have to recommend benefits such as home-safety improvements and prepared meals.

In-home help

Medicare Advantage plans also will have the option to pay for assistance from home health aides, who can help beneficiaries with their daily activities including dressing, eating and personal care. These benefits represent a revised and broader definition of the traditional requirement that Medicare services must be primarily health related.

Plan test drives

New regulations will let people try an Advantage plan for up to three months and, if they aren’t satisfied, they can switch to another Medicare Advantage plan or choose to enroll in original Medicare. Congress required this flexibility in the 21st Century Cures Act, designed to accelerate innovation in health care.

Also of Interest

Learn more at AARP’s Medicare Resource Center

by T.R. Reid, AARP, September 4, 2018

CMS Sends Clear Message to Plans: Stop Hiding Information from Patients

CMS Sends Clear Message to Plans: Stop Hiding Information from Patients

Part of the continued roll-out of American Patients First, CMS sends letter to Part D plans explaining that gag clauses that keep patients from knowing how to get the best deal are completely unacceptable.

Today, the Centers for Medicare & Medicaid Services (CMS) sent a letter to companies that provide Medicare prescription drug coverage in Part D explaining that so-called “gag clauses” are unacceptable, as part of the Administration-wide “American Patients First” initiative to lower prescription drug costs.

In Part D, Medicare pays prescription drug plans to cover medicines, which beneficiaries buy at a pharmacy. Gag clauses are provisions in contracts that insurance plans and their pharmacy benefit managers enter into with pharmacies. These clauses prevent pharmacists from telling patients when they could pay less for a drug by paying cash, instead of billing their insurance and paying the required copay or deductible.

“President Trump and Secretary Azar are committed to lowering drug prices, and CMS today took another important step to help patients who are feeling the pain,” said CMS Administrator Seema Verma. “Many patients don’t know that some drugs are actually more expensive when they use their insurance. What’s worse is that some pharmacy benefits managers are preventing pharmacists from telling patients when this is happening, because they get a share of the transaction when the patient uses their insurance. Today we are taking a significant step towards bringing full transparency to all the back-end deals that are being made at the expense of patients.”

A copy of the letter that was sent to all Part D Plan Sponsors today is included below, and to learn more about the President’s blueprint to lower prescription drug costs, please visit: http://hhs.gov/drugpricing.

To view Unacceptable Pharmacy Gag Clauses letter click here.

New Medicare Cards Protect Your Personal Information

New Medicare Cards Protect Your Personal Information

https://www.medicare.gov/new card

Starting in April 2018, Medicare will mail new Medicare cards to all people with Medicare, to help protect you from identity fraud. Fraudsters are always looking for ways to get your Social Security Number so they’re removing Social Security Numbers from all Medicare cards to make them safer.

Your new card will have a new Medicare Number that’s unique to you. The new card will help protect your identity and keep your personal information more secure. Your Medicare coverage and benefits stay the same.
And there’s more good news—Medicare will automatically mail your new card at no cost to the address you have on file with Social Security. There’s nothing you need to do! If you need to update your official mailing address, visit your online my Social Security account or call 1-800-772-1213.

Once you get your new Medicare card, take these 3 steps to make it harder for someone to steal your information and identity:

1. Destroy your old Medicare card right away.
2. Use your new card. Doctors, other health care providers, and plans approved by Medicare know that Medicare is replacing the old cards. They are ready to accept your new card when you need care.
3. Beware of people contacting you about your new Medicare card and asking you for your Medicare Number, personal information, or to pay a fee for your new card. Treat your Medicare Number like you treat your Social Security or credit card numbers. Remember, Medicare will never contact you uninvited to ask for your personal information.

This information was taken from: https://blog.medicare.gov/2018/01/25/new-medicare-cards-protect-personal-information/