Senior Health plans & Medicare Guru

12/25/2023

Wishing all of our Facebook family and friends across the miles all the joys of this wonderous season. May the New Year be filled with health and happiness.

06/17/2021

Information released from CMS for Part D drug coverage for 2022.

Q1Medicare Update of the Day:
Although we have just started 2021 . . . you can now get a preview of your 2022 Medicare Part D drug plan coverage. Last Friday, CMS released the finalized 2022 Medicare Part D standard prescription drug plan parameters along with additional guidance for 2022 and 2023 Part D plans. For more details see: https://Q1News.com/885.html

06/16/2021

I took action today, writing to my Senators urging them to take action on the 2 midnight rule. Fixing this issue will save Medicare Beneficiaries some major $$$

Senate: Fix Medicare’s “Two Midnight” Rule!
1730 actions taken
270 needed to reach next goal
Bipartisan companion legislation has been offered in the U.S. Senate to address Medicare’s “two midnight” policy; S. 2048, Improving Access to Medicare Coverage Act. Many Medicare beneficiaries are classified as being on “observation,” which can result in significantly higher claims and prevent Medicare coverage from being applied for nursing home care for patients who do not have a 3-day inpatient hospital stay. This bill has bipartisan sponsors in Senators Sherrod Brown (D-OH), Susan Collins (R-ME), Sheldon Whitehouse (D-RI), and Shelley Moore Capito (R-WV). This bill would allow observation stays to be counted toward the three-day mandatory inpatient stay for Medicare coverage of a skilled nursing facility (SNF). CMS has temporarily suspended this rule due to the pandemic; it is time to end it for good.

Currently, Medicare beneficiaries who are not officially admitted to a hospital may be classified under “Observation Status,” which is treated as an outpatient procedure for billing purposes. New evidence data shows that beneficiaries who are poor and live in rural areas are disproportionately affected and tend to cycle repeatedly through the hospitals but those who receive the appropriate services do not. Unfortunately, the common practice of placing a beneficiary on “observation status” can have significant financial consequences for Medicare beneficiaries, since Medicare Part A and its related coverage rules only apply to actual inpatient care admissions. This may lead patients, many who are extremely sick and may need skilled nursing care to spend many days in the hospital and be charged for services that Medicare would have otherwise paid had they been admitted. Furthermore, hospitals have up to one year to retroactively change admission status to observation, leading unsuspecting beneficiaries with thousands of dollars in bills for SNF care they believed would be covered by Medicare.

This legislation would help close this loophole and provide an important consumer protection for Medicare beneficiaries who may be placed under observation status. This would allow for patients who are placed under observation status to count their stay towards the three-day mandatory inpatient stay under the two-midnight policy for Medicare coverage of skilled nursing facility services, and prevent patients from being denied Medicare benefits. Beneficiaries could also avoid receiving unexpected bills for services, such as prescription medications, that otherwise would have been covered under a hospital admission.

NAHU is calling on all members who work in Medicare to contact their Senators and urge them to co-sponsor bipartisan legislation that would address this important issue.

06/11/2021

New drug to help treat Alzheimer’s. Price tag will add substantial cost to Medicare. We will be watching to see how this plays out.

The question of what would happen when a new, expensive prescription drug comes to market for a disease like Alzheimer’s that afflicts millions of people has loomed large in discussions over drug p…

03/04/2021

Important information about COVID vaccines and Mammograms. Timing is important to avoid false negatives.

Getting your mammogram or other diagnostic imaging exams soon after the COVID-19 vaccine may affect your test results due to lymph node swelling caused by vaccination. Here’s what to know if you're getting vaccinated soon and are due for a mammogram or other diagnostic imaging test.

10/01/2020

Medicare part B premiums for 2021.

The Medicare trustees forecasted in April that the standard 2021 Part B premium would rise to $153.30 in 2021 from $144.60 this year ($8.70 more monthly, or a 6% increase). However, the trustees’ report noted that the impacts of Covid-19 were unknown and therefore could not be factored into the estimates.

While many of Medicare’s 62.7 million beneficiaries are protected from large Part B premium hikes, others are not. And, higher-income beneficiaries already pay extra each month.

We are still awaiting the final numbers for a Medicare part B premiums for 2021 as well as the deductibles for parts A&B for 2021.

07/18/2020

Good news for people over 65. If this bill passes COBRA would be considered credible coverage‼️

Yesterday, the U.S. House Committee on Energy and Commerce unanimously advanced the Beneficiary Enrollment Notification and Eligibility Simplification (BENES) Act (H.R. 2477). Next steps for the bill include consideration by the full House.

07/15/2020

Some sobering news’s from doctors about the consequences of lockdowns and COVID-19 fear. There are so many other diseases going untreated that will have massive consequences some deadly.

“It is impossible to overstate the short, medium, and long-term harm to people’s health with a continued shutdown…from missed cancer diagnoses to untreated heart attacks and strokes to increased risks of suicides,” physicians warn.

06/03/2020

Medicare Advantage Star Ratings for 2021. Unintended consequences!

The Trump administration’s effort to lower the administrative burden on providers may have an inadvertent effect on calculating star ratings for Medicare Advantage plans, insurers say.

05/27/2020

Be on the look out for part D plans and Medicare Advantage plans that offer this in their 2021 plans. 1 in 3 Medicare beneficiaries is diabetic.

WASHINGTON (AP) — Many Medicare recipients could pay less for insulin next year under a deal President Donald Trump announced Tuesday in a pivot to pocketbook issues important in November's...

01/23/2020

Finally something the left and the right in Washington can agree on!

Two House bills, H.R. 1667 and H.R. 2564, also address the COBRA bite problem.