Medicare Part B Patients Should Get A Premium Rebate

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

elderly asian woman sitting with caregiver - Pacific Grove in Home Personal Care

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

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.

It’s Important To Get Regular Health Checkups

Doctor Robert Califf in white color coat and colorful tie

Many seniors, particularly men, don’t go to their primary physician for regular checks.  It’s likely due to a fear of them finding something wrong.  However, a study that was done in 2019 found that having 10 additional primary care doctors per 100K people increases a community’s average life expectancy by 51.5 days.  This is due to the fact that more doctor visits leads to more vaccinations and screening tests.  Medicare pays for a free annual wellness visit.

Medicare Advantage Plans Routinely Deny Claims And Deny Services

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/

Medicare Advantage Plans Add More Perks

Choosing a Medicare Advantage program that is right for you can be difficult due to the wide range of things that they cover—or don’t.  Plans are expanding benefits in 35 out of 41 categories this year, according to a study done by actuarial consultant Milliman.  Vision coverage still ranks as the most common supplemental benefit, with 97% of Advantage plans offering it in 2022, followed closely by hearing (94%), fitness (94%) and dental care (91%).  However, less common benefits like acupuncture and coverage for bathroom safety devices with the number of plans featuring these increasing by 70% and 32%, respectively (Kiplinger’s Retirement Report May 2022, page 15).

Inflation Driving Seniors Back Into The Workforce

A glass jar filled with dollars was placed on the table

Inflation in the U.S. hit a 40 year high of 7.9%, which is causing financial problems for many seniors.  Economists say that this is forcing many retirees back into the workforce.  Thankfully, this may ease staffing shortages which has hit a number of industries.  “We’re beginning to see the migration of the older cohort who expected to live on fixed income in a low interest-rate and low-inflation environment, Joseph Brusuelas, chief economist at RSM US LLP, told The Wall Street Journal.  “Really what you’re dealing with is an inflationary shock that has elicited a change in behavior,” he said.   The share of people over 55 either working or looking for a job rose to 38.9% in March from 38.4% in October.  That translates to more than 480K people in that age group entering the labor force during the last six months.

New Alzheimer’s Drug Could Hit The Market In 2024

A doctor shows the tablet to the senior female patient

Biotech company Alzheon Inc. just raised $50 million in venture capital to complete clinical trials of an oral medication which will be used to treat Alzheimer’s disease.  The drug will be tested in a late-stage Phase 3 clinical trial with 300 people.  If the study is successful, Alzheon expects to seek FDA approval for the drug in 2024.  Sadly, another recent drug to hit the market called Aduhelm by Biogen is not available for widespread use after Medicare said last week it would only cover the cost of the drug for patients enrolled in a clinical trial.

Free COVID-19 Tests Rolling Out For Seniors On Medicare

Millions of seniors on Medicare can get up to eight free coronavirus home tests each month from pharmacies at more than a dozen national and regional chain retailers.  This has been a long time coming but I will certainly keep my eyes peeled to see if these show up on the shelves.  Locations which are now committed, according to the Centers for Medicare and Medicaid Services, are Albertsons, Costco, CVS, Food Lion, Giant, Hannaford, H-E-B, Hy-Vee, Kroger Family, Rite Aid, Stop & Shop, Walgreens and Walmart.

https://www.usatoday.com/story/news/health/2022/04/04/covid-tests-medicare-pharmacies-free/7265479001/

 

Medicare Under Fire For Not Covering Most Claims For New Alzheimer’s Drug, Aduhelm

Drugmakers and patient advocacy groups are pushing back against a federal proposal to cut off most Medicare payments for a new drug from Biogen Inc. to treat Alzheimer’s, called Aduhelm.  The Centers for Medicare and Medicaid Services last month proposed to limit coverage of the drug to patients enrolled in clinical trials which are sanctioned by the agency.  The proposal would apply to similar drugs still in development and not yet approved that work by reducing amyloid protein in the brain.  The high cost of the drug and questions over its efficacy are behind the decision of the Centers for Medicare and Medicaid Services.