Medicare

Medicare supplement plans the best help for effective health insurance

If you are willing to get the best help from your Medicare health insurance plans it is the most essential to have Medicare supplement insurance plans ready with your original Medicare plans. In fact the point is that the Medicare health insurance plans are actually supplementary health insurance plans needed to bridge up the gap left behind by the original Medicare health insurance plans. In this respect it is very essential to note that there are a lot of things to consider in this respect. In fact the point is that the Medicare supplement insurance provides a good deal of benefits along with providing the best coverage of the gaps left behind by the original Medicare health insurance plans. Besides that it should also be kept in mind that each and every Medicare supplement plan have their own set of benefits. Therefore it is very much essential to make the choice of your Medigap plans very carefully. In this respect is always a better idea to seek the idea of some professional expert who can provide the best guidance in your decision of choosing the most suitable Medicare supplement health insurance for yourself.

Other than that there are also certain other things that should be kept in mind in this respect. One of the most notable fact in this regard is that the Medicare supplement plans are actually supplementary insurance plans to the original Medicare therefore these policies cannot be sold independently. Therefore one must be first get enrolled to the original Medicare part A and B to get enrolled for the Medicare supplement plans. Other than that it should also be kept in mind that once enrolled to the Medicare supplement health insurance plans one must continue being a beneficiary of the Medicare original plans in order to get the benefits of the original Medicare plans. In fact the point is that if you switch over to any other plan other than the original Medicare say for example the Medicare advantage plan you can no longer use the benefits of the original Medicare. You can only use the benefits of your Medigap plans only if  you switch back to original Medicare plans.

Other than these there are also some other things that should be kept in mind in this respect. In fact the point is that the Medicare supplement plans were originally standardized in 1992 and since then there had been 12 standard Medicare supplement health insurance available to the Medicare beneficiaries sold and administered by the private health insurance companies. But since July 2010 a few new changes have been brought in the standard Medicare supplement plans. According to the recent changes four of the existing plans have been dropped and in their place two new plans M and N are introduced. These plans use the means of deductible and cost sharing offers a good deal of help to the Medicare beneficiaries for that extra coverage and to get better benefits from the Medicare original plans. Therefore, the fact is that getting enrolled to the Medicare supplement plans offers the best help to cover up the gap between the original Medicare policy coverage and the actual medical bill payable.

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Weiner Challenges the Republicans to Put-Up or Shut-Up on Healthcare

Weiner Challenges the Republicans to Put-Up or Shut-Up on Healthcare

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New Look for Medicare Advantage Plans

Medicare and Medicaid provide benefits to an estimated 100 million people, but these centers have not had a permanent chief executive since the fall of 2006.

President Obama intends to nominate Harvard professor and Massachusetts pediatrician Donald Berwick, who is known for his work to improve patient care, to oversee Medicare and Medicaid. Berwick heads a nonprofit organization for improving efficiency in health care. He is the president and CEO of the Institute for Healthcare Improvement, a nonprofit organization in Cambridge, Mass. The Institute works to eliminate needless deaths, suffering, waiting for help, and waste within health care systems around the world.

Berwick is also a professor of pediatrics and health care policy at Harvard Medical School, and a professor of health policy and management at the Harvard School of Public Health.

How Health Care Reform Impacts Medicare

The final health care reform bill did not include Medicare benefit cuts. It did not increase the share you pay for doctor office visits, hospital stays, prescription drugs, or any other medical treatment under Medicare.

The final bill phased out what’s called the doughnut hole. That’s a gap in Medicare coverage that leaves beneficiaries to pay full price for prescriptions and premiums. Medicare beneficiaries who fall into the coverage gap will receive a 0 rebate this year, and a 50-percent discount on brand-name drugs next year. The percentage that beneficiaries pay for prescriptions will decrease each year until the gap in coverage is eliminated.

After that, Medicare beneficiaries will pay about 25 percent for their prescriptions after they’ve paid a deductible until they reach catastrophic coverage. Then, they will pay only 5 percent, and will no longer have to pay full price for prescriptions except during the deductible period.

Health Care Reform Promotes Prevention

Parts of the reform legislation are designed to improve health care quality, and prevent the need for hospitalization by supporting preventive care. The bill eliminates co-pays and deductibles for preventive care, and provides coverage for annual check-ups.

Hospitals will also receive incentives to be sure people are ready to go home when released, and to prevent unnecessary readmissions. Doctors will be encouraged to coordinate the care that patients receive from different specialists to eliminate gaps in treatment.

Medicare Savings to Extend Medicare Benefits by Nearly a Decade

The health care reform bill had over 0 billion in Medicare savings over the next decade. Most of those savings result from reducing annual increases in payments to home health agencies, hospitals, and skilled nursing facilities. The annual increase would be reduced by a productivity factor to encourage providers to be more efficient.

A 1997 bill reduced Medicare spending by more than the current health care reform, but Congress has passed bills to moderate those 1997 cuts to Medicare. Congress could do the same for the current health care reform provisions. While the current reform has no pay cuts for doctors, previous legislation did pass with pay cuts for doctors that will take effect on April 1st of this year, and in the years to come.

Changes to Medicare Advantage Plans

Medicare now pays 14 percent more per enrollee to private Medicare Advantage plans than the same care would cost under original Medicare. The final health reform bill brought these payments more in line with original Medicare. Medicare Advantage plans still have to provide coverage that is as good or better than original Medicare, and Medicare Supplement Plans still cover gaps in the original Medicare.

The bill prevents Medicare Advantage plans from charging more than original Medicare for specific services. It also requires Medicare Advantage plans to spend at least 85 percent of taxpayer funds on medical services for members, instead of using that money for marketing or keeping it as profits. Members who see premium increases, or benefit reductions in their Medicare Advantage plans can change to another plan or original Medicare.

The Congressional Budget Office (CBO) estimates that the combination of Medicare savings, and increased revenues in the bill more than pay for coverage for the uninsured. As a result, the CBO says the bill will reduce the deficit over the first ten years as well as long-term to make Medicare available to seniors retiring in coming years.

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Turning 65 Means More Choices for Boomers Comparing Medicare, Employer Healthcare Plans

Turning 65 Means More Choices for Boomers Comparing Medicare, Employer Healthcare Plans

Belleville, IL (Vocus/PRWEB) April 05, 2011

Reaching 65 is an important turning point for many baby boomers—whether they are retiring from work or not. If they remain employed, however, boomers have the added complexity of factoring Medicare into their employer-provided healthcare decisions, according to Allsup, a nationwide provider of Medicare plan selection services and Social Security disability representation.

In the past 10 years, the number of people working past age 65 has climbed 52 percent, according to U.S. Bureau of Labor Statistics data. More companies also are taking steps to coordinate their healthcare coverage options for employees who are eligible for Medicare.

“One of your first steps is learning what your employer will provide you once you reach 65,” said Adrienne Muralidharan, senior product specialist for the Allsup Medicare Advisor®. The Allsup Medicare Advisor is an impartial Medicare plan selection service that helps people understand and choose the most affordable and appropriate Medicare coverage for their healthcare needs. (Allsup is not a Medicare plan provider and does not accept commissions from insurance providers.)

The number of large companies offering retiree health benefits has declined from 40 percent in 1995 to 28 percent in 2010, according to the Kaiser Family Foundation. For some, employer coverage is the primary payer of benefits, with Medicare paying costs not covered by the employer plan. For other employees, the reverse is true.

“It can be confusing to determine how your employer coverage coordinates with Medicare,” Muralidharan said. “When you add in decisions about spouse and dependent benefits, it can become even more complicated.”

Below, Allsup reviews key questions people turning 65 should consider when deciding their healthcare coverage needs.

    Do you still work and have healthcare coverage through your existing employer?
If you continue to work, you may be able to keep your employer’s existing group health plan (GHP). Confirm that your employer will continue covering you. In some instances, GHPs can choose to drop or reduce coverage for Medicare-eligible employees. In these cases, the employer may offer “wrap-around” or supplemental coverage, and the individual must enroll in Medicare for primary coverage.

If your company has more than 20 employees, the GHP is the primary payer in most instances and Medicare acts as the secondary payer. Traditional Medicare has two parts, Part A is hospital coverage and Part B is medical services. Generally, everyone should take Part A when they become eligible since it is free. You have the option of enrolling and paying the monthly premiums for Part B coverage. If you don’t enroll in Medicare Part B, you need to get a deferral from Medicare so that you are not subject to penalties when you enroll in the future.

If your employer has fewer than 20 employees, Medicare becomes the primary payer and your employer’s plan is the secondary payer. In this instance, it’s essential to enroll in Medicare Parts A and B. If you don’t enroll, then generally, you will have to pay from your own pocket anything that Medicare would have covered. “Make sure you get in writing details about your employer-provided coverage,” Muralidharan advises. “This will help you to decide how to handle your Medicare choices.”

    Does your spouse work and have employer-provided healthcare coverage?
You may be able to move to your spouse’s healthcare plan if it would provide you with equal or better coverage than Medicare. Again, determine how the plan would coordinate with Medicare (for example, as primary or secondary payer).

    Are you retired and do you have retiree health benefits through your former employer?
If you have coverage as good or better than Medicare under your retiree benefits and your retiree healthcare plan allows, you may be able to defer Medicare Part B. However, some retiree plans stipulate that Medicare is the primary payer and the retiree plan is the secondary payer. Therefore, you need to understand how much coverage is provided under your retiree health plan to determine if you need additional Medicare coverage.

    Are you eligible for veteran healthcare benefits?
Veteran healthcare benefits, in general, are covered when provided at U.S. Department of Veteran Affairs (VA) facilities or for services authorized by the VA. Depending upon the level of VA benefits you receive, you may be adequately covered and don’t need Medicare coverage. But, some people find that Medicare offers more flexibility and choose to use a Medicare plan as well. VA benefits and Medicare do not coordinate.

    Do other family members rely on your healthcare plan for coverage?
If you are turning 65 and your spouse or your children are covered under your employer’s healthcare plan, you need to consider how their coverage may change if you choose to switch to Medicare. For example, will they be eligible for COBRA or need to secure private coverage? This is becoming increasingly important as children up to age 26 can now remain on their parent’s healthcare plan. “Before changing any coverage for yourself, you want to make sure you have secured coverage for anyone else included on your policy,” Muralidharan said.

Choosing Medicare Coverage

Whether seeking a deferral or enrolling in Medicare, it is important to understand options provided under the federal healthcare program. This includes the alphabet of Medicare programs: Part A-hospital, Part B-medical, Part C-Medicare Advantage and Part D-prescription drug, and Medigap. In most instances, regardless of the path you take, it’s generally a good idea to enroll in Part A, as it’s available at no cost. Enrollment in the other parts depends on several factors, including those outlined above. Consumers also need to evaluate the options under each type. For example, most people can choose from dozens of Medicare Part D, Medicare Advantage and Medigap plans.

“Your healthcare needs are unique to you, so it can be important to have help in determining which plan best meets your needs,” Muralidharan said. “It’s not surprising many people find this is a confusing process, especially if you are trying to coordinate Medicare with your other options.”

To help people who are new to Medicare, Allsup has released a free guide, “Medicare and Reaching Retirement Age.” It is available by phone: (866) 521-7655, or email: MedicareHelp(at)allsupinc(dot)com.

For an evaluation of your Medicare options, please call an Allsup Medicare Advisor specialist at (866) 521-7655 or go to http://medicare.allsup.com.

About Allsup

Allsup is a nationwide provider of Social Security disability, Medicare and Medicare Secondary Payer compliance services for individuals, employers and insurance carriers. Founded in 1984, Allsup employs more than 700 professionals who deliver specialized services supporting people with disabilities and seniors so they may lead lives that are as financially secure and as healthy as possible. The company is based in Belleville, Ill., near St. Louis. For more information, visit http://www.Allsup.com.

The information provided is not intended as a substitute for legal or other professional services. Legal or other expert assistance should be sought before making any decision that may affect your situation.

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Medicare Questions Cleared

CVS Caremark chief medical officer Dr. Troyen Brennan spoke to Harry Smith about the prescription drug plan for seniors Medicare Part D and how to pick the best drug plan.
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Hcpcs National Level Ii Medicare Codes – Long Description – Diskette

Hcpcs National Level Ii Medicare Codes – Long Description – Diskette

List Price: $ 131.95

Price: $ 131.95

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Valuable Information On California Medicare Supplements

Several individuals who put in for the Medicare program opt to cover a mixture of additional costs and services with the use of California Medicare supplements or a different existing policy. Several of these harmonize with the original Medicare plan, eg Medigap, where others present different manners in receiving the benefits of Medicare. In total there are 9 separate programs that can be obtained to make the Medicare plan more suitable to your wishes.

Employer Group Medical Coverage: If you are above sixty five and still in employment then it is probable that you might have a work sponsored health cover arrangement. If you choose to additionally enlist for Medicare then this will be secondary to the employer’s set up. This is plus the case if you are aged below sixtyfive and have registered for Medicare due to a permanent disability.

Retiree Plans: There are some citizens that get a variety of medical coverage as a part of their retirement plan. The benefits of this can vary very much. Certain plans may insure medical expenses that are not incorporated in Medicare, eg vision care. Quite a few of these programs may be offered by means of Part C of Medicare – Medicare Advantage. A business is within rights to revise the conditions of a retiree program and the entire program can be lost if the firm goes into insolvency.

CalCOBRA and COBRA: These are Central laws which demand that an employer is required to enlarge for an amount of time the group medical coverage for a member of staff, or their family members, if given circumstances take place for example redundancy. If you elect to put in for Medicare then you will lose your COBRA cover, this plus is the same for a CalCOBRA program.

TFL (TriCare For Life): The TriCare plan is one that provides medical insurance to all retirees from a uniformed service as well as their husband or wife and children. The Tricare For Life plan is for those folks that become Medicare entitled. These folks must enlist for both Part A and Part B of Medicare. This scheme will encompass the majority of supplemental health requirements and too involves a broad coverage for prescription drugs.

Veteran Affairs Benefits: Age no matter, a veteran is entitled to a health program known as the Medical Benefits Package. This is an especially popular system for ex-servicemen as there are no premiums to pay. It covers the fee of fundamental medical care and additionally medications. Some VA plans will furthermore deal with the charges for dental care, eyeglasses, and nursing home care. The department of Veteran Affairs encourages those people that put in to also carry on with supplementary health cover such as Medicare.

Medi-Cal: Whether a person is entitled to this scheme depends upon their monetary belongings and their monthly pay. If you have signed up for a Medicare plan and too are entitled for Medi-Cal, then Medi-Cal will pay the Medicare Part B premium if you have no further arrangement of medical insurance. When seeking treatment it is crucial to decide on a medical doctor or facility which accepts both Medi-Cal and Medicare. There are several services associated with Medi-Cal which are not covered by Medicare, eg hearing aids or eye glasses.

Medicare Savings Program: There are lots of national plans that aid with Medicare expenses. Several of these provide the cash required for the premium for Medicare Part B. To qualify for one of these plans you are required to meet explicit asset and take-home pay circumstances.

Medigap: These schemes, as well known as Medicare supplement cover, can be given by private insurance firms. There are twelve assorted policies, these are labelled A upto L and will insure the expense of all or a share of the Medigap deductibles and coinsurance. It is probable that several of the policies will plus give additional cover to what is normally allowed by way of Medicare. The benefits of a medigap policy can not be changed once you sign up. Plus the program is not permitted to be stopped by the supplier unless you fail to pay, but it is possible for the corporation to increase the monthly premium.

Medicare Advantage: Part C of the Medicare cover is also called Medicare Advantage. It is a helpful way to attain additional benefits exceeding what is usually agreed with the Medicare program. The cover is handled by commercial insurance agents who are sponsored by Medicare for each individual that opts in. To be entitled to join a Medicare Advantage program it is required to have formerly registered for Parts A and B of Medicare.

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ADVISING YOUR CLIENT ON HOW TO SELF-ADMINISTER A MEDICARE SET-ASIDE

All attorneys practicing in the area of workers’ compensation today must have at least a basic understanding of the Medicare Secondary Payer Statute.  Although most have a handle on the pre-settlement requirements of the Statute, many still do not fully comprehend the post settlement requirements enough to adequately advise and protect their clients.  This article seeks to shed some light on the post-settlement requirements of the Medicare Secondary Payer Statute and provide some guidance to attorneys so as to avoid dissatisfied clients and possible professional liability.                 

One of the first and most important decisions an attorney must make when settling a case involving a workers’ compensation Medicare set-aside (WCMSA) is how the account is going to be administered. The Centers for Medicare and Medicaid Services (CMS) allows a WCMSA to be either professionally or self-administered.  The cost of hiring a professional to administer a WCMSA over the claimant’s entire life expectancy is often too expensive for either party to seriously consider.   The result is that a large number WCMSA accounts are self-administered by the Claimant.  Although, there is no requirement that the WCMSA be administered according to any formal written instrument, such as a trust or custodial agreement, CMS’ guidelines can be very difficult to implement and claimants rarely have the experience or knowledge to properly administer a WCMSA.  It is therefore imperative that a claimant be advised in detail as to what the responsibilities and potential pitfalls are as administrator so that they can make an informed decision whether, and how to properly administer the account.  An attorney must know when self administration is not appropriate or advisable.  Where a Claimant is incompetent, has very little education, is unable to read, speak or write English or the there is the threat of family misappropriation of the funds, Claimant’s counsel should strongly recommend professional rather than self administration. 

A Claimant who has decided to self-administer must first be educated as to what a WCMSA is, and why a portion of their settlement has been put into this account. As the administrator of the account, a Claimant will often be called on to explain why medical providers should be paid out of the WCMSA account rather than billing Medicare directly.  If the administrator does not understand why the WCMSA has been set up, they will certainly not be able to effectively communicate the need to use the account with a medical provider. At the very least, a Claimant’s attorney must make sure their client understands the underlying principle that Medicare is a considered a “secondary payer” in situations where another party, such as a workers’ compensation carrier could be responsible for their injuries. Clients must understand that their workers’ compensation settlement cannot shift the responsibility of their medical care from the workers’ compensation insurance company to Medicare.  They should be fully aware that WCMSA funds should only be used to pay for medical services related to their work injury that would normally be paid by Medicare.  Any items not covered by Medicare should not be paid from the WCMSA account.  Claimants should know that Medicare does not pay for items such as acupuncture, routine dental care, eyeglasses, hearing aids and certain types of prescription drugs.  If the administrator makes an improper distribution from the WCMSA, Medicare will not cover the claimant’s future injury-related medical expenses until the funds are returned to the WCMSA and then expended properly.      

It is recommended that you provide your client with a copy of the booklet “Medicare & You” which can be obtained from any local Social Security office for a more extensive list of services not covered by Medicare.  If you or your clients have questions regarding Medicare’s coverage of a specific item or service to determine if you they can pay for it from the WCMSA account you should inform them to call 1-800-MEDICARE (1-800-633-4227). 

It is important to note that the administrator of the WCMSA does not need to determine how much Medicare pays for a particular item or service.  The administrator also does not need to consider or calculate Medicare deductibles or co-payment amounts.  CMS does however, require that the administrator pay the services from the account in the same manner in which the WCMSA was calculated and funded.  Accordingly, the Claimant needs to know how the WCMSA was calculated and funded.  

A WCMSA must be calculated and funded by using either “full actual charges” or the worker’s compensation fee schedule from the state where the claim was brought.  Whether medical expenses are to be paid on a “full and actual” basis or at workers’ compensation fee schedule rates will be referenced in the WCMSA submission to CMS.  Future prescription drug costs must be priced and paid based upon the average wholesale price. Failure to pay medical expenses in the manner in which the WCMSA was calculated, could lead to a premature exhaustion of the WCMSA funds. It is therefore very important that the Claimant be advised how the WCMSA was calculated and at what rates the bills should be paid.[1]  It is strongly recommended that the Stipulations not only specify the amount of the WCMSA but also how it was calculated so that the Claimant clearly understands how expenses are to be paid out of the account. 

In order for the WCMSA to be effective, a copy of the final settlement agreement must be forwarded to the Coordinator of Benefits. Forwarding a copy of the approved stipulations to the MSA vendor, or directly to the Medicare Coordinator of Benefits (COB), must be part of your post settlement process.  If CMS does not receive a copy of the approved stipulations they will not consider the process complete and will not recognize the settlement. 

Once the stipulations are approved and forwarded to the Coordinator of Benefits, the WCMSA funds must be placed in an interest-bearing account, separate from their personal savings or checking account.  All interest or investment yield earned must remain in the account. As administrator of the account, the Claimant will be responsible for keeping accurate records of establishing the account as well as of all payments made from the account.  These records may be requested by CMS’ lead Medicare contractor as proof of appropriate payments from the WCMSA account.  Although CMS requires these records be retained for seven years, it is highly recommended that the Claimant retain the records until CMS provides confirmation that all of the WCMSA funds were properly exhausted.  

The Claimant may use the WCMSA account to pay for photocopy charges, postage and banking fees that are directly related to the account.  The funds may now also be used to pay capital gains taxes associated with the interest earned on the account. CMS does not allow the WCMSA funds to be used for payment of fees for trustees, custodians, administrators or any other professionals hired to assist in administration of the account. Additionally, the funds in the WCMSA may not be used to pay premiums for Medicare supplemental (“Medigap”) insurance for the beneficiary.

 The Claimant must annually, sign and forward a self-attestation form demonstrating that payments from the WCMSA account were made appropriately and only for treatment or services related to their work-related injuries that would otherwise be reimbursable by Medicare.  The annual accounting shall be submitted no later than thirty days after the end of each year, beginning one year from the establishment of the WCMSA account.  Annual self-attestation should continue through depletion of the WCMSA account to the CMS lead Medicare contractor. CMS has the right to demand and receive a complete accounting of payments made from the account at its discretion.  A final self attestation should be forwarded to CMS once the WCMSA account becomes permanently depleted. 

WCMSA’s that are funded by an annuity have different rules as to when Medicare will begin paying for services.  Once the initial seed money and any annual annuity payment are exhausted from the account, Medicare will pay for injury related treatment for the remainder of that year.  When the account is funded by another annuity payment, Medicare will again refuse to pay for treatment or prescription drugs until the Claimant proves they have exhausted the funds in the account for that year.  If the funds in a given year are not exhausted, the excess funds must be carried over to the next period.  This then increases the amount that must be exhausted in the next period before Medicare will pay for treatment or prescription drugs.           

If five years have elapsed from the approval of the WCMSA, and the WCMSA funds are not being expended as projected, CMS will consider allowing the release of some of the funds from the account.  In order to do this, a new proposal must be submitted demonstrating that the Claimant’s condition has improved enough to justify at least a 25% reduction in the remaining balance of the WCMSA funds.   The new proposal should include all documentation, including an opinion from the treating physician, demonstrating how the Claimant’s condition has improved and what previously recommended treatment is no longer reasonable and necessary.  Only after CMS approves the new proposal may the excess funds be withdrawn. The cost of submitting the new proposal may not be paid out of the WCMSA account.

If the WCMSA funds still remain in the account at the time of the Claimant’s death, the remaining balance should be distributed in accordance with any will or the laws of intestacy of the State in which the account was created.  The administrator or executor of the Claimant’s estate should keep the account open for a reasonable period before disbursing the remaining funds to insure that all injury related bills are properly paid.  If the administrator or executor of the estate is uncertain whether there are still outstanding injury-related medical bills, it is recommended that the account remain open for as long as 2 1/2 years from the last medical service provided, as medical providers have twenty-seven months from the date of service to bill Medicare.  After the administrator or executor of the estate is certain that all medical bills have been paid, they should petition CMS to dissolve the WCMSA and release the funds to the estate or designated beneficiary.

Informing your clients regarding the process and rules for administering their WCMSA account is not only good practice, it can help insure your client’s Medicare coverage is not improperly interrupted.  Informing yourself of the requirements of the Medicare Secondary Payer Statute is the first step in that process.  The most prudent way of insuring that your client has received and understands this information is by including language in the full and final stipulations.  By including language in the stipulations, the Claimant not only signs off that he understands the consequences of non-compliance, but also provides the added security of the Commission canvassing them on these issues before the stipulations are approved.  Another method is by having the Claimant sign a separate Informed Consent that acknowledges that you have gone over the requirements of administering the WCMSA with them.  Whatever method you chose, it is imperative that Claimants be fully informed and provided with all the necessary resources and support before allowing them to self-administer their WCMSA account.     

[1] Although providers are not required to take the workers’ compensation fee schedule after a case is settled, the Claimant should make every effort to have the doctor continue to bill them based upon the fee schedule.  If the provider refuses to accept payment in the manner the WCMSA is set up, the Claimant should document their efforts to be billed in the appropriate manner. 

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Healthcare Reform, Coverage Changes Highlight Key Questions for Medicare Annual Enrollment Season, Allsup Says

Healthcare Reform, Coverage Changes Highlight Key Questions for Medicare Annual Enrollment Season, Allsup Says

Belleville, Ill. (Vocus) October 13, 2009

More than 600,000 seniors and people with disabilities will be required to choose new healthcare coverage during the upcoming Medicare annual enrollment because their current plan is being eliminated. However, millions more could benefit by changing to a plan that better fits their needs, according to Allsup, a nationwide provider of Social Security disability representation and Medicare services.

“Annual enrollment is the best, single opportunity to examine your Medicare coverage to make sure it truly meets your needs,” said Paul Gada, Allsup’s personal financial planning director and product manager for Allsup Medicare Advisor®. Allsup Medicare Advisor is a Medicare plan selection service that helps people understand and choose the most affordable and appropriate Medicare plan for their healthcare needs. (Allsup is not a Medicare plan provider.)

“If there is a gap between what you need to cover your healthcare costs and what you have right now – this is the time to close the gap,” he said.

Medicare annual enrollment runs from Nov. 15 through Dec. 31, providing seniors and those with disabilities a finite amount of time to evaluate their options. Below, Allsup outlines common questions people have about annual enrollment.

Medicare Annual Enrollment: Common Questions

1. What are the biggest Medicare changes for 2010?

Traditional Medicare is not experiencing any changes in 2010. However, Medicare Advantage plans and prescription drug plans, or Part D plans, are experiencing changes.

About 18 percent of Medicare Advantage plans are being eliminated, generally because they were too similar to other plans offered by the same company or had very low enrollment. Medicare Advantage plans are private Medicare plans that offer the same coverage as traditional Medicare, plus may include additional benefits such as prescription drug coverage and vision, hearing and dental care. Even with the reduced number of Medicare Advantage plans, there are still thousands available.

Some prescription drug plans are also leaving the market, but many still remain. Stand-alone Part D plans and drug formularies in Medicare Advantage plans also may add or drop coverage for certain prescription medications and experience premium changes. “You want to make sure the prescription drugs you take are still covered under your current plan,” Gada said.

“This is the best time to take a look at what your plan covers, how that is changing for next year and the impact on your healthcare needs and expenses,” he added.

2. Will healthcare reform affect my 2010 Medicare options?

No. The proposed legislation won’t affect Medicare plan options for 2010.

3. How will costs change for 2010?

A majority of Medicare participants will not see an increase in the basic premium they pay for traditional Medicare. Premiums will increase for some Medicare Advantage and Medicare prescription drug plans.

The average monthly premium for Medicare Advantage plans will increase by $ 7 to $ 39. However, nearly 87 percent of Medicare beneficiaries have access to Medicare Advantage plans that do not require additional premiums. Additionally, more Medicare Advantage plans available for 2010 will cap out-of-pocket costs to $ 3,400 or less, providing beneficiaries with an added protection against unexpected costs.

The average monthly premium for prescription drug coverage (Part D) also will increase by $ 2 to $ 30. Most Medicare Advantage plans include prescription drug coverage, so this increase generally applies to only those choosing traditional Medicare with an additional prescription drug plan.

4. Why would I want to change plans?

Reasons people change plans include:

You are unhappy with your existing coverage or provider;
You are experiencing changes in your health;
You expect changes in medical needs for the coming year; or
Your current plan has changed and no longer meets your needs.

As with other insurance, you should shop around at least every few years to ensure you are getting the best value. “Take a look at your costs for 2009. What did you pay for your premiums, co-pays and deductibles?” asked Gada. “Then consider whether your coverage matched your needs. Did you have a hospital stay? Did you make several visits to your family doctor, or did you visit specialists, too?

“If your costs were too high or you paid more than you expected to, then you owe it to yourself to see if there is a plan that better meets your needs,” Gada said.

5. What changes can I make during annual enrollment?

You can:

Move from traditional Medicare to a Medicare Advantage plan;
Move from a Medicare Advantage plan to traditional Medicare; or
Add a Medicare prescription drug plan (Part D) if you do not have prescription drug coverage.

6. If I decide to change plans during annual enrollment, what do I need to do?

You need to identify and enroll in the new plan before Dec. 31. You can research the available plans and enroll on your own, or you can use the experienced help of an independent Medicare plan selection service like Allsup Medicare Advisor. Because most people have dozens of plans from which to choose, they can make the process easier on themselves by using an objective Medicare specialist, who helps identify the best plans for their needs and assists with Medicare enrollment.

7. If I do not want to change plans, how do I keep the plan I have?

If you do nothing, you are re-enrolled in your current plan. If you are in a Medicare Advantage plan and it is being terminated, and you do nothing, you will be enrolled automatically in traditional Medicare. Keep in mind that traditional Medicare may have higher out-of-pocket expenses and more limited coverage than your previous Medicare Advantage coverage, so this may not be the optimal choice.

8. Where can I get more information?

All Medicare beneficiaries enrolled in a Medicare plan should receive annual enrollment information from their Medicare Advantage or Medicare Part D plan. Additionally, Medicare beneficiaries should receive a copy of the 2010 Medicare & You book from the Centers for Medicare & Medicaid Services (CMS). For additional Medicare assistance, Allsup offers a free screening to help you determine eligibility for Allsup Medicare Advisor at http://ama.allsup.com.

About Allsup

Allsup is a nationwide provider of Social Security disability, Medicare and workers’ compensation services for individuals, employers and insurance carriers. Celebrating its 25th anniversary in 2009, Allsup employs more than 600 professionals who deliver specialized services supporting people with disabilities and seniors so they may lead lives that are as financially secure and as healthy as possible. The company is based in Belleville, Ill., near St. Louis.

For more information, visit http://www.Allsup.com.

The information provided is not intended as a substitute for legal or other professional services. Legal or other expert assistance should be sought before making any decision that may affect your situation.

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Medicare Supplement Policies Available in Gwinnett County

Medicare supplement policies’ availability varies based on geographic region. If you are interested in purchasing a Medicare supplement policy, you will first have to inform your broker, or insurance carrier, of your zip code in order for them to tell you which Medicare supplement policy is available in your area. Medicare supplement policies are identified by letters, such as A through L, although new Medicare supplement policies are being introduced this year. Those Medicare supplement policies will be named M through P, at this time.

If you do a search using the zip code 30024, in Gwinnett county, you will find that the Medicare supplement policies available include A, B, C, D, F, G, K, and L. Please note that each of these Medicare supplement plan will have the same benefits, regardless of which company you purchase it from. However, every insurance carrier will set whatever price they want on it. Therefore, it is important that you shop around to get the best deal. A licensed insurance broker can help you find the best value on a Medicare supplement policy in your particular area.

The estimated costs for an older adult for the above Medicare supplement policies will range from 00 to 50 per year. Some of these Medicare supplement policies include benefits for meeting the Part A deductible, Part B deductible, Part B excess charges, and skilled nursing facility costs. The different Medicare supplement plans will have different combinations of benefits, premiums, deductibles, and included services. They will all include basic benefits, although those vary by Medicare supplement plan also.

The focus of all of the Medicare Supplement policies, however, is to help cover the gap in what traditional Medicare does not cover, and what the member will be required to pay. Therefore, the benefits include additional moneys and benefits for services that are included in Medicare. For example, Medicare will pay all but ,100 for hospital stays per day. Medicare supplement plan L will pay an additional 5 per day per hospital stay. This means the member will end up only having to pay 5, rather than the original ,100 balance. Obviously, this is a huge significant benefit to Medicare members, and that is why many of them purchase Medicare supplement policies, in additional to their traditional Medicare, Part A and B.

While traditional Medicare Part B typically pays 80% of covered services, after the deductible has been met, the member would then be responsible for the remaining 20%. With certain Medicare supplement policies, the Medicare supplement plan would pay 15% of the remaining balance, which means the member will then only be responsible for a 5% coinsurance. The savings with prescription drugs are equally beneficial too.

As you can see, a Medicare Supplement plan really benefits those members enrolled in traditional Medicare, even though they are already receiving benefits. It is important to research your particular geographic area to see which Medicare supplement plans are available for you, and what their premiums and benefits are. You can choose the particular plan that you like the best, and then you should compare prices among several different insurance carriers, to see which one offers the best deal. Be sure to check with a knowledgeable insurance broker if you need help making a decision, or getting Medicare supplement plan quotes.

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