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SHINE: Serving the Health Insurance Needs of Everyone

Can I still change my Medicare Plan?

Lorraine York Edberg headshotLorraine York-EdbergThe 2017 Medicare Open Enrollment period ended on December 7, but some people may still be allowed to change plans.

For those with a Medicare Advantage Plan: Between January 1 and February 14, you can leave your plan and switch to Original Medicare, but you cannot switch to another Medicare Advantage Plan. If you drop your Medicare Advantage plan during this period, you will be able to join a Medicare Prescription Drug Plan to add drug coverage. Your Original Medicare coverage and your prescription drug coverage will begin the first day of the month after your enrollment. You may also add a supplement (Medigap) at this time. This could be very helpful for those who missed the Annual Open Enrollment Period and wish to make a change.

Additionally, for those who are dually eligible for Medicare and MassHealth or those with Prescription Advantage, the state of Massachusetts Prescription Assistance Program or Medicare beneficiaries eligible for Low Income Subsidy program administered through Social Security, also known as “Extra Help,” a program that assists with drug plan premiums and lowering the costs of prescription drugs:

  • You can change your plan anytime during the year.
  • Those who are dual eligible or have “Extra Help” can change every month.
  • Those with Prescription Advantage members can do this only once each year.

For those of you that found your medications were not covered under your current plan this year, you may still have some options. You should make an appointment to review your circumstances with a trained SHINE counselor.

Trained SHINE (Serving Health Insurance Needs of Everyone… on Medicare) volunteers can help you! The SHINE program, Serving Health Information Needs of Everyone, provides free, confidential and unbiased health insurance counseling for Medicare beneficiaries. To reach a trained and certified counselor in your area, contact the Regional Office at 1-800-498-4232 or 413-773-5555 or contact your local Council on Aging. For other SHINE related matters, call 1-800-AGE-INFO (1-800-243-4636), then press or say 3. Once you get the SHINE answering machine, leave your name and number. A volunteer will call you back, as soon as possible.

Medicare Part B premiums, deductibles and coinsurance for 2018

Lorraine York Edberg headshotLorraine York-EdbergOn November 17, 2017, the Centers for Medicare and Medicaid announced the Part A and B premiums and deductibles for 2018.

These figures are based on the Social Security Cost of Living increase of 2% for 2018 which equates to $20 monthly for every $1000 received.

The standard monthly premium for Part B enrollees will be $134 monthly, the same amount it was in 2017.

In 2017, the Medicare “hold harmless” provision protected 70% of Medicare beneficiaries from increases in their Part B Premium. That protection does not allow the Part B premium to increase greater than the dollar increase in their Social Security check.

In 2018, 30% of all Part B enrollees who are not subject to the “hold harmless” provision will pay the full premium of $134 per month. An estimated 42% of all Part B enrollees are subject to the hold harmless provision in 2018, but will pay the full monthly premium of $134, because the increase in their Social Security benefit will be greater than or equal to an increase in their Part B premiums up to the full 2018 amount. Of all Part B enrollees, 28% are subject to the hold harmless provision in 2018 and will pay less than the full monthly premium of $134, because the increase in their Social Security benefit will not be large enough to cover the full Part B premium increase.

However, the hold harmless rule also does not protect high-income Medicare beneficiaries whose individual income is above $85,000 or a couple’s joint income above $170,000. These beneficiaries will pay an increased amount for their Part B and Part D, called an income-related monthly adjustment amount, also known as “IRMAA.” The Federal government bases the 2018 adjustments on the beneficiaries’ 2016 Federal Income taxes. You may request a new initial determination through Social Security if believe your IRMAA is incorrect by contacting your local Social Security office. Some other beneficiaries will be paying higher Part B premiums if they are on Medicare Part B, but not yet collecting their Social Security benefit.

The monthly Part B premium for those who are enrolled helps pay for doctors' services, x-rays and tests, outpatient hospital care, ambulance service, medical supplies, and other medical equipment. 

The 2018 Part B deductible will be $183 for all people with Medicare, the same as the annual deductible in 2017. The Part B deductible is annual; once you have incurred $183 of expenses for Medicare-covered services in any year, the Part B deductible does not apply to any further covered services you receive for the rest of the year.

Medicare Part A (Hospital Insurance) helps pay for hospital care, skilled nursing care, home health care, hospice care, and other services. The Part A deductible will increase from $1,316 to $1,340. For beneficiaries with Medicare only, the Part A deductible is the beneficiary’s only cost for up to 60 days of Medicare-covered inpatient hospital services. The 61st to the 90th day has increased from $329 to $335 a day, and beyond the 90th day has increased from $658 to $670 a day. For beneficiaries who have a Medigap plan to supplement Medicare, often most of these costs are covered by their supplemental insurance.

The skilled nursing facility coinsurance increased from $164.50 to $167.50 for the 21st to the 100th day. Medicare A covers the first 20 days in a skilled nursing facility, after a three-day qualifying stay in a hospital.

Many Medicare beneficiaries purchase additional insurance to cover the gaps of Medicare to help reduce out-of-pocket expenses.

This article is based on a news release from the Centers for Medicare and Medicaid Services.

The SHINE Program, Serving the Health Insurance Needs of Everyone… with Medicare, provides free, confidential, and unbiased health insurance counseling for Medicare beneficiaries. To reach a trained and certified counselor in your area, contact the Regional Office at 1-800-498-4232 or 413-773-5555 or contact your local council on aging.

Medicare Open Enrollment begins October 15

Lorraine York Edberg headshotSHINE Regional Program Director Lorraine York-EdbergIf you have Medicare, sometime during the month of September you will be receiving important information known as an Annual Notice of Change from your Prescription Drug Plan or your Medicare Advantage Plan, HMO (Health Maintenance Organization), or PPO (Preferred Provider Organization). The mailing will explain any changes to your plan in the coming year regarding premiums, drug coverage changes (formulary), providers, and restrictions. It is very important to review the letter to make sure the plan still works for you. Starting October 15 through December 7 is the time when you can join, drop, or change your insurance, and the new coverage will begin on January 1, 2018.  

I like to call this time of year “Your Annual Insurance Checkup,” because it a time when you can evaluate your current plan and decide if you want to make changes. If the plan you are in continues to meet your needs, then you may want to keep it. It is also a time where you may want to shop around for a new plan to help you save money, decrease or increase coverage.

Important things to consider when reviewing your plan changes are:

  • Does it still cover all your medications?
  • Are there any restrictions on your medication like quantity limits, prior authorization or step therapy that would make it difficult to access your needed medications?
  • Did you get a letter from your Medicare Prescription Drug Plan that your plan is changing or is no longer available in Massachusetts?
  • Have you been reassigned to a new plan? If so, contact the new plan to assure it will cover your current medications. If it will not, you should join a new plan before December 7, 2017, to access the medications you need without any problems.
  • Would you like to join a Medicare Prescription Drug Plan or Medicare Advantage Prescription Plan? Because you’ve never joined previously – you can do it during this time.

Review and save all letters from your plan!

During the Medicare Open Enrollment (October 15 - December 7), you will have an opportunity to CHANGE your coverage for next year. You can decide to stay in Original Medicare or join a Medicare Advantage Plan. If you are already in a Medicare Advantage Plan, you can use the Open Enrollment to switch back to Original Medicare with a Medicare Prescription Drug Plan. State-certified SHINE (Medicare) counselors can help you understand your plan changes, as well as other options you may have. Call early to get a SHINE appointment (1-800-498-4232) during Open Enrollment!

Ways to get the help you need:

  • Visit medicare.gov/find-a-plan to use the Medicare Plan Finder.
  • Look at your most recent “Medicare and You” handbook to see plans in your area; 2018 books will be mailed late September.
  • Call 1-800-MEDICARE (1-800-633-4227) and say “Agent.” Help is available 24 hours a day, including weekends.
  • Contact your local SHINE Program.
  • Attend a local Presentation regarding the Annual Open Enrollment Period

The SHINE Program, Serving the Health Insurance Needs of Everyone, provides free, confidential, and unbiased health insurance counseling for Medicare beneficiaries. For further assistance with any Medicare issue, you can make a SHINE appointment. To reach a trained and certified counselor in your area, contact the regional office at 1-800-498-4232 or 413-773-5555 or contact your local council on aging.

Post-hospitalization skilled nursing facility care: Will Medicare cover your stay?

If you are a Medicare beneficiary, Medicare can pay for up to 100 days of care in a Skilled Nursing Facility (SNF) such as a nursing home. Usually, in order to qualify for Medicare coverage, you must have a qualifying hospital stay of three consecutive days or more (often referred to as the “three midnights rule”) and you must need and receive doctor-ordered skilled care or therapy on a daily basis. However, being in the hospital for three days does not guarantee that Medicare will pay for SNF care. The stay must also be classified as an “inpatient” hospitalization.

Why is this important?

In recent years, some Medicare beneficiaries have been admitted to a hospital for days, if not weeks, at a time, and thought they satisfied the three-day hospitalization requirement. But actually, during that time their hospital classified them as being under “observation status.” When a person stays in a hospital under “observation status,” instead of as an “inpatient,” those days in the hospital will not count as part of the three hospital days they need so that Medicare will cover their care at a Skilled Nursing Facility. Not only does classification as “inpatient” or “observation” status impact whether Medicare will pay for a patient’s SNF stay, but also it can change the amount the patient will pay for the services and medications received while in the hospital.

How do I find out which category applies to my situation?

Fortunately, as of March 8, 2017, hospitals are required to give Medicare patients both oral and written notice when they are categorized as “observation” status patients for 24 hours. The written notice, called the Medicare Outpatient Observation Notice (“MOON”), should be given directly to the patient or the patient’s representative. The notice must be provided no later than 36 hours after observation services are initiated or, if sooner, upon release. The patient or their representative is supposed to sign the notice to confirm receipt and to confirm that he or she understands the notice. Medicare estimates that approximately 1.4 million MOONs will be delivered annually.

Remember: if you go to a skilled nursing facility after an “observation” status hospital stay, Medicare may not pay for your care.

If you are a Medicare beneficiary facing possible SNF care after a hospitalization, you should take the following steps to protect your right to appropriate Medicare coverage:

  • Review any notices you receive from your medical providers, including any MOON-related paperwork.
  • Make sure to ask your doctor or other hospital staff whether you are considered an “inpatient” or whether you are under “observation” status. Be aware that some hospitals change a person’s status during the course of his or her stay, so ask this question multiple times when you are in the hospital.
  • If you think you should be an “inpatient,” speak to your physician, your care manager, and/or other hospital staff about having your classification changed from “observation” to “inpatient.”

The Medicare Advocacy Project (MAP) is devoted to assisting people who may have been wrongfully denied Medicare. If you have questions about your Medicare claims or need legal advice, contact your local MAP office via Greater Boston Legal Services at 1-800-323-3205. For residents of central and western Massachusetts, contact Community Legal Aid at 1-855-252-5342.

The SHINE program, (Serving Health Information Needs of Everyone… on Medicare), provides free, confidential and unbiased health insurance counseling for Medicare beneficiaries. To reach a trained and certified counselor in your area, contact the regional office at 1-800-498-4232 or 413-773-5555 or contact your local council on aging.

Better protection for 57.7 million Medicare beneficiaries

Lorraine York Edberg headshotSHINE Regional Program Director Lorraine York-EdbergOn May 31, 2017, Centers for Medicare & Medicaid Services (CMS) released a news article regarding changes coming in April of 2018 which will make changes to 57.7 million Medicare beneficiaries. Medicare is working to remove Social Security numbers from Medicare cards. Through this initiative, the CMS will prevent fraud, fight identity theft and protect the private healthcare and financial information of Medicare beneficiaries.

This initiative has been pushed and supported by congress since 2004 when the Government Accountability Office, an investigative arm of Congress, urged officials to curtail the use of Social Security numbers as identifiers. In 2007, the White House Office of Management and Budget told agencies to “eliminate the unnecessary collection and use of Social Security numbers” within two years. In 2015, President Obama requested $50 million as a down payment “to support the removal of Social Security numbers from Medicare cards” for the 2016 budget. 

CMS will issue new Medicare cards with a new randomly-assigned number called a Medicare Beneficiary Identifier (MBI) to replace the existing Social Security-based Health Insurance Claim Number (HICN) both on the cards and in various CMS systems we use now. The new identifier will be 11 characters long and will include letters and numbers. Medicare will start mailing new cards to people with Medicare benefits in April 2018. All Medicare cards will be replaced by April 2019.

“We’re taking this step to protect our seniors from fraudulent use of Social Security numbers which can lead to identity theft and illegal use of Medicare benefits,” stated CMS Administrator Seema Verma. “We want to be sure that Medicare beneficiaries and healthcare providers know about these changes well in advance and have the information they need to make a seamless transition.”

Providers have also received information regarding these changes as they will need to adjust and make changes to their data management systems currently in place. There will also be a 21-month transition period where providers will be able to use either the MBI or the HICN during the transition.

This article was based on a CMS press release dated May 31, 2017. Click here for more information from CMS.

The SHINE program, (Serving Health Information Needs of Everyone… on Medicare), provides free, confidential and unbiased health insurance counseling for Medicare beneficiaries. To reach a trained and certified counselor in your area, contact the regional office at 1-800-498-4232 or 413-773-5555 or contact your local council on aging.