Medicare AARP Plan Attacked From An Unexpected Source

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We all know how hard it is shopping for a supplemental Medicare Plan, also known as Part D.  The Wall Street Journal recently took issue with AARP’s marketing of products like health, life and auto insurance, saying, for instance that the AARP MedicareRX Preferred Plan, insured by UnitedHealth Group Inc., carries the highest premium among all national stand-alone Medicare drug plans.  AARP has advocated that the 1.74 million members who make up 9% of the market for Part D plans should switch to a cheaper policy.  Kaiser Family Foundation backed up this opinion stating in a report that, “We’re certainly at the point where this AARP plan is so expensive that it’s likely that most people in it could save money by switching,†according to Juliette Cubanski, co-author of a report on the issue.

Medicare Catastrophic Coverage Cap Starts In 2025 : Too Late For Many

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The climate health bill recently passed by Congress provides quite a bit of relief for seniors.  However, the fact that not all provisions kick in next year has some seniors worried.  USA Today recently profiled Jackie Trapp, one of more than 1.3 million Americans whose drug spending exceeds Medicare;’s definition of “catastrophic†coverage.  Jackie has incurable blood cancer and is on a chemotherapy regimen which costs $240K per year and results in $21,740 in out-of-pocket expenses for the drug Revlimid.  “We used to donate a healthy amount to charity.  Now, I’m receiving charity,†she told USA Today.

Medicare Open Enrollment From October 15 To December 7 : Check Your Options!

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Medicare Open Enrollment arrives, with their Annual Election Period (AEP) running from October 15 to December 7.  Those who are in a standalone Part D drug plan should check and make sure that they have the best coverage possible for the prescription medication that they are on.  Coverage and plans change every year so getting the right plan could save you hundreds or even thousands of dollars per year.  Similarly, if you are looking at a Medicare Advantage Plan should look at your likely health needs, including hospitals, doctors, durable equipment, as well as prescription costs.  Alliance on Aging has a number of free presentations on this topic.  Click here for the dates and locations.

Medicare Part B Bills To Decline 3% Next Year

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For the first time in a decade, Americans will be paying less next year for Medicare Part B.  The 3% decrease in premiums (a savings of $5.20 per month for most people) comes after a tough year with extremely high inflation.  “To millions of seniors and people with disabilities on Medicare, that means more money in their pockets while still getting the care they need,†President Biden said.

 

Walmart And United Healthcare Form Joint Venture For Medicare Advantage Enrolles

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Walmart announced that it is rolling out a major partnership with UnitedHealth Group to provide healthcare services and improve the patient experience for Medicare Advantage enrollees in certain markets.  The 10-year partnership was announced Wednesday.  The duo will begin the rollout in Florida and Georgia in 2023, where Walmart Health has a combined 15 locations.  Eventually, they plan to roll out the service across the country.  “No matter who your insurer is, this 10-year collaboration is going to enable us to deliver the care needed, first in Georgia and Florida,†Dr. Cheryl Pegus, EVP of Walmart Health & Wellness, said in an interview.  Medicare Advantage plans have increased in popularity in recent years, with the program adding more than 2 million beneficiaries in 2022, boosting the program to 45% of Medicare enrollees, according to a study by The Chartis Group.

President Biden Signs Sweeping Prescription Drug Reform

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On August 16, President Joe Biden signed the Inflation Reduction Act which includes:

About $370 billion into policies aimed at reducing U.S. Greenhouse gas emissions.  $10’s of billions of dollars will go toward supporting renewable energy development, lowering the costs of electric vehicles, building out public electric car charging stations, etc.

The bill is the most significant prescription drug legislation to pass in 20 years. Diabetic seniors won’t have to pay more than $35 a month for insulin.  Starting in 2026, out-of-pocket costs for all prescription drugs will be capped at $2,000 a year for Medicare recipients.

Because the bill raises more revenue through higher taxes than it spends, it’s projected to reduce the federal budget deficit by close to $300 bill over the next ten years.

 

Medicare Part B Patients Should Get A Premium Rebate

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Advocates for participants in Medicare Part B such as AARP are arguing that they should be seeing a premium rebate this year, although it’s unlikely that this will happen.  The reason:  the fund has a large surplus after adding on $21.60/month, a record price increase.  It’s estimated that roughly $10/month to cover the cost of the new Alzheimer’s drug Aduhelm.  The annual cost of the drug was $28,200 but the Centers for Medicare and Medicaid Services (CMS) refused to cover it even though it received FDA approval and the drug was pulled from the market.  “It is unconscionable for a single outrageously priced drug to drive up premiums for all Medicare beneficiaries,†sadid Nancy LeaMond, AARP chief advocacy and engagement officer.  She ways savings from Aduhelm should be swiftly returned to Medicare Part B users.

Monterey, CA Medicare Equipment Rules

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If you have recently been released by CHOMP, or Community Hospital of the Monterey Peninsula, you may be wondering what equipment Medicare will pay for.  It really comes down to what is essential versus what is a convenience.  For instance, Medicare will pay for a motorized scooter if that’s the only way that you can get around your house, but they won’t pay if it’s mostly for longer outdoor excursions.  Check with your Medicare Advantage plan.  Some have benefits like home improvements such as wheelchair ramps.  To find out for sure, call the Medicare hotline at 1-800-633-4227 or go to www.medicare.gov.

Medicare Can Not Ding You For Having Pre-Existing Health Conditions

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Some worry that when they sign up for Medicare, they will pay more if they have pre-existing health conditions.  That’s not true for Medicare or Medicare Advantage (MA) and Part D prescription plans.  This also holds true for supplemental policies (Medigap) only if you sign up for it during your six-month Medigap open enrollment period.  If you want it later, an insurance company can charge you more or refuse to sell you a policy because of your health status.

Source AARP Bulletin, June 2022.

Medicare Advantage Plans Routinely Deny Claims And Deny Services

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Sadly, a recent report from the U.S. Department of Health and Human Services inspector general found that 18% of claims that they examined were denied which actually should have been covered.  The denials were often a result of errors in processing claims.  The review also found that the plans turned down 13% of authorizations for medical services that government-run Medicare would have allowed.  The results of the study covered 15 of the largest Medicare Advantage plans in the nation.  The investigators said the Medicare Advantage plans use the same tactics that private insurance companies use to get out of paying legitimate claims in order to reduce costs.  The report recommends more government oversight of the plans.

https://www.usatoday.com/story/news/health/2022/04/28/medicare-advantage-plans-claims-care-federal-report/9569198002/