New to Medicare Part B? Don’t forget to schedule Your Welcome to Medicare Visit!

Medicare examThe Welcome to Medicare visit is not the same as a routine physical exam or annual Medicare Wellness visit. The Welcome to Medicare visit is supposed to be an introduction to Medicare and should focus on disease prevention and detection to help you live a healthier life. It is sometimes referred to as the “Initial Preventive Physical Exam”… or IPPE.  The Welcome to Medicare visit is a one-time-only visit covered by Medicare Part B. That means that you don’t have to pay a co-pay or coinsurance — there is no additional cost to you. You have twelve months from the date of your initial enrollment into Medicare Part B to complete the visit.

During your Welcome to Medicare Preventive Visit, you and your doctor should discuss disease education and prevention. Your doctor should also review your medical and health history, such as:

  • Past medical/surgical history, such as illness, hospital stays, operations, allergies, and injuries
  • Current medications and supplements, including over-the-counter vitamins
  • Depression and safety screening
  • Family health history
  • History of alcohol, tobacco, and illicit drug use
  • Diet
  • Physical activities

The visit will also include:

  • Measurements for:
    • Height
    • Weight
    • Blood pressure
    • Body mass index
    • A simple vision test – (Not normally covered by Medicare)
    • A written plan for screenings, shots and other preventive services you may need
    • In some cases, a discussion about creating an advanced directive

If diagnostic tests or other services are performed that are not covered by the Welcome to Medicare visit, you may be responsible for co-pays and coinsurance.

You should take the following items with you to your visit: Medical records, including immunization records; a detailed family health history; and a full list of medications and supplements, including vitamins.


Take control, take the test for HIV

Did you know that about 1 in 7 of the more than 1 million Americans infected with Human Immunodeficiency Virus (HIV) don’t know they’re carrying the virus?

And, about 1 in 4 people in the U.S. who test positive for HIV are tested too late to get the full advantage of treatment. The good news is that testing is an important first step in getting HIV-infected people the medical care and support they need to improve their health and help them maintain safer behaviors – and Medicare can help.

Medicare covers HIV screening for people with Medicare of any age who ask for the test, pregnant women, and people at increased risk for the infection (such as gay and bisexual men, injection drug users, or people with multiple sexual partners).

HIV is the virus that can lead to Acquired Immunodeficiency Syndrome, or AIDS. There have been many advances in treatment, but early testing and diagnosis play key roles in reducing the spread of the disease, extending life expectancy, and cutting costs of care.

Take control and take the test. Visit Health & Human Services’ website to learn more about National HIV Testing Day, June 27 and watch our video.

Filed under: Uncategorized
Source: Medicare

Medicare Enrollement Periods Explained!

Medicare Enrollment Periods Explained!

There are five different enrollment periods for Medicare!  It’s no wonder everybody gets confused!  I will simplify it all for you here.

Initial Enrollment Period: There is a seven-mont Initial Enrollment PeriodConfused about Medicare, for people Turning 65 and enrolling in Medicare.  It includes the three months before the month that you turn 65, your birthday month, and the three months afterwards. This applies to all forms of Medicare—Parts A (hospital), B (doctor and outpatient expenses), C (Medicare Advantage), and D (prescription drugs).

Medicare Supplement Enrollment: There is a separate six-month open enrollment period for Medicare Supplement policies (also called Medigap), which begins when you’ve turned 65 , or enrolled in Part B. During this period, insurers must sell you any Medicare Supplement policy they offer…no medical questions asked!   They can’t charge you more because of your age or health condition. This guaranteed access is very important because if you miss this window and try to buy a policy later, insurers are not be obligated to sell you a policy.  You may be turned down for coverage based on your health history or charge you more money.

General Enrollment: If you missed enrolling in Part A or B during the Initial Enrollment Period, there is also a General Enrollment Period from January 1 through March 31 of each year. Waiting until this period could mean lifetime premium surcharges for late Part B enrollment, which can end up costing you thousands of dollars. And your coverage won’t begin until July.

If you enroll in Part B during the General Enrollment Period, there is another period which starts April 1 and goes through June 30—during which you can sign up for a Medicare Advantage plan with or without Part D drug coverage. In most cases, coverage also will take effect July 1.

Part D drug coverage  – If you don’t sign up for it when you first can, and later decide you want it, you will face potentially large premium surcharges if you were without coverage for 63 days or more.

Special Enrollment: There are lots of special conditions that can expand your penalty-free options for when you sign up for Medicare, such as employer coverage, or moving (for MA and Part D coverage).

 Open Enrollment: If you already have Medicare, there is an Open Enrollment Period every year, when you can select a new Medicare Advantage or Drug Plans. You also have the option of moving back and forth between Original Medicare (Parts A and B) and Medicare Advantage. It runs from October 15 through December 7.

For those with Medicare Advantage plans, there is one more time period you need to be aware of.  From January 1 through February 14, there is the Medicare Advantage Disenrollment Period.  During this time, you can move back to Original Medicare and also get a Part D plan if you need one..(if your Medicare Advantage plan included Part D coverage.)

It certainly is confusing, but a good insurance agent will help keep you informed, and walk you through the process!

What’s The Difference Between a Doctor “Accepting Medicare” or accepting “Medicare Assignment”?

It’s important to know that not all doctors bill the same way. Some doctors accept “Medicare Assignment” and agree to the rates Medicare sets and takes those amounts as full payment. Other doctors participate in the Medicare program but do not accept Medicare Assignment.

Accepting Medicare Assignment

Doctors who accept Medicare Assignment agree to be paid by Medicare. They submit the claim to Medicare and agree to accept the Medicare-approved dollar amount for a procedure. They can’t charge you more than that amount. You will still be responsible for dedcuctibles, co-pays and coinsurance (often 20%), but your share is limited by what Medicare pays.

Not Accepting Assignment

Some doctors participate in the Medicare program but do not agree to accept Medicare Assignment. Under the rules of Medicare Part B, doctors are allowed to charge you a an additional 15%, on top of the 20% you are already responsible for, if they accept Medicare, but not Medicare Assignment.  These are referred to as “excess charges”.  So in reality, you would be responsible for 35% of the bill, instead of 20%.  When looking at Medicare Supplements, be sure to check if your plan will pay these “Excess Charges” or not.

The best way to find out whether or not your doctor accepts Medicare Assignment is to call the doctor’s office directly.. Continue reading

Medicare Part D: Learn About the Medicare Part D Coverage Gap (Donut Hole)

Hitting the Donut Hole

The donut hole, or coverage gap, is one of the most controversial parts of the Medicare Part D prescription drug benefit and of concern to many people who have joined a Part D drug plan.  All Part D plan have the donut hole (coverage gap), as it is mandated by the Federal Government.  It is slowly being closed, but will not be fully closed until 2020.

Although all prescription drug plans must explain the coverage gap in their literature and advertising, the donut hole comes as a shock to many enrollees when they go abruptly from making copayments for their drugs to paying 45% of the cost of Brand Names and 65% of the cost for Generics.

In addition, you may be confused about the $2,960 limit for 2015 in your initial coverage period, thinking it is only the amount of money you would have to pay out-of-pocket. In fact, the amount includes the total cost of your drugs, meaning what you paid plus what the drug plan paid.

How the Donut Hole Works in 2015

If you join a Medicare prescription drug plan, you may have to pay up to the first $320 of your drug costs. This is known as the Deductible.

During the initial coverage phase, your drug plan pays 75% of the covered prescription drug costs after your deductible is met, and you pay 25% until the total drug costs (including your deductible) reach $2,960.

Once you reach $2,960 in total drug costs, you will be in the donut hole and you must pay 45% of the cost of Brand Name medication and 65% of the cost of Generic drugs until your total out-of-pocket cost reaches $4,700. This annual out-of-pocket spending amount includes your yearly deductible and copay amounts.

When you spend more than $4,700 out-of-pocket, the coverage gap ends and your drug plan pays most of the costs of your covered drugs for the remainder of the year. You will be responsible for a copay of $2.65 for each generic drug and $6.60 brand name drugs (or 5%, whichever is higher). This is known as catastrophic coverage.

The expenses outlined above only include the cost of prescription medications. It does not include the monthly premium that you pay to the prescription drug plan.Donut hole 2015 donut-hole


June 5th is World Environment Day – a day for encouraging awareness and action for the environment that’s celebrated in over 100 countries worldwide.  How can you make your voice heard this year?  One great way is to sign up to get your “Medicare & You” handbook electronically.

If you have an eReader (like an iPad, Kindle Fire, Surface, or Galaxy Tab) you can download a free digital version of the Medicare & You handbook to your eReader and take it with you anywhere you go.

Don’t have an eReader? You can still sign up to get a paperless version in a few simple steps. We’ll send you an email in September when the new eHandbook is available. The email will explain that instead of getting a paper copy in your mailbox each October, you’ll get an email linking you to the online version of “Medicare & You.” This online version of the handbook contains all the same information as the printed version.

Even better, the handbook information on is updated regularly, so you can be confident that you have the most up-to-date Medicare information!

Sign up today to get your Medicare & You information electronically, and you’ll be making a difference for the environment. What a great way to make your voice heard and celebrate World Environment Day.

Filed under: Uncategorized
Source: Medicare

Paying for Medicare Out-of-Pocket Expenses

Medicare beneficiaries need to pay a significant portion of their health care costs. Medicare requires beneficiaries to pay premiums, deductibles and coinsurance. But there’s a lot you can do to keep these costs manageable. Here are some steps to minimize Medicare’s out-of-pocket costs.


Premiums: Most people aren’t charged a premium for Medicare Part A hospital insurance. The standard monthly premium for Medicare Part B medical insurance is $104.90 in 2015. This amount is typically deducted from your Social Security check if you are already receiving payments, but those who have not yet claimed Social Security will receive a bill. People with adjusted gross incomes above $85,000 for individuals and $170,000 for couples are charged higher Part B premiums.


It’s important to sign up for Medicare Part B during the initial enrollment period, which is a seven-month window that begins three months before your 65th birthday. Your Part B premiums will increase by 10 percent for each 12-month period you were eligible for Medicare Part B but didn’t sign up for it. If you are 68 when you sign up for Medicare Part B, you will be hit with a 30 percent premium increase every year for the rest of your life, If you didn’t sign up for Medicare Part B at age 65 due to participating in group health insurance through your job, you should sign up within eight months of leaving the job or the coverage ending to avoid the penalty.


Deductibles and coinsurance: The Medicare Part B deductible is $147.00 in 2015. Once retirees meet the deductible, they typically need to pay 20 percent of the Medicare negotiated cost for each service. Any time you have any serious medical issues, that 20 percent is going to be a serious amount of money. If the doctor does not accept “Medicare Assignment”, you could also be hit with an additional 15% (Excess Charges), on top of the 20%. There is no annual limit on out-of-pocket costs with Medicare. Medicare Part A has a $1,260.00 deductible (per benefit period) for beneficiaries who are hospitalized.


Supplemental insurance: Medigap policies are supplemental insurance plans that will pay for the copayments, coinsurance and deductibles of traditional Medicare and sometimes extra services in exchange for an additional premium. “A Medigap policy will cut down your irregular out-of-pocket costs, The Medigap initial enrollment period occurs during the first six months you are 65 or older and enrolled in Medicare Part B. After this period ends, you could be denied the right to purchase a Medigap policy or charged significantly higher premiums based on your medical history.


Preventative care: Medicare covers a variety of preventative care services with no cost-sharing requirements, including a free annual wellness visit, flu shots and screenings for a variety of illnesses. Vaccines and preventative exams are fully covered as well as some outpatient stuff. However, conditions discovered during these preventative care visits could require additional tests or treatments that do have an out-of-pocket cost, sometimes even during a visit that you thought would be completely covered. You will be required to pay for it if another procedure is done.


Prescription drug coverage: You can sign up for Medicare Part D beginning three months before you turn 65. A late enrollment penalty is added to your Part D premium if you go 63 or more days without prescription drug coverage after age 65. Medicare Part D premiums, deductibles, coinsurance, copays and covered medications vary depending on the plan you choose and change each year, even if you stick with your existing plan. You can switch Medicare Part D plans during the open enrollment period from October 15 to December 7. You are allowed to change plans every year without penalty, and I recommend that people do it. Even if your drugs don’t change, the policies of the plan might change. It’s important to examine how your costs and coverage will change each year, and consider switching if you can find coverage that suits your needs at more affordable prices.


Medicare Doesn’t Cover Everything: While Medicare covers many of the services people need, there are a few common medical services that it doesn’t. Medicare won’t pay for eyeglasses, hearing aids or dental care. Most significantly, Medicare doesn’t typically cover extended nursing home stays or other types of long-term care. Things like vision care, eyeglass, hearing aids, dental care and non-prescription drugs, these are all things that Medicare doesn’t cover at all. Those are things that you need to figure out another way to pay for.

Traveling abroad? Check health coverage off your to-do list first!

If you’re planning a vacation abroad, you already know that there’s a lot to do before you leave. There are suitcases to pack, an itinerary to plan, and perhaps a passport to renew. We want you to have a fun, relaxing trip – so don’t forget to include health coverage on your to-do list.

If you have Original Medicare, your health care services and supplies are covered when you’re in the U.S., which includes Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands.

But, if you plan to travel overseas or outside the U.S. (including to Canada or Mexico), it’s important to know that in most cases, Medicare won’t pay for health care services or supplies you get outside the U.S. (except in these rare cases).

That doesn’t mean you have to travel without coverage. There are several ways you can get health coverage outside the U.S.:

  1. If you have a Medigap policy, check your policy to see if it includes coverage outside the U.S.
  2. If you get your health care from another Medicare health plan (rather than Original Medicare), check with your plan to see if they offer coverage outside the U.S.
  3. Purchase a travel insurance policy that includes health coverage.

In all 3 cases, check with your policy or plan before traveling and make sure you understand what is covered outside the U.S. For information on other foreign travel situations (like a cruise, dialysis, or prescription drugs) you can watch this video.

Taking the time to plan out your health coverage before you travel abroad will help you to have an enjoyable and relaxing trip. For more information on how to stay healthy abroad, visit the Centers for Disease Control’s Traveler’s Health page.

Filed under: Uncategorized
Source: Medicare

Health screenings save men’s lives

Are you the type of guy who puts off doing a task and later wishes he’d just done it? If you’re a man with Medicare, now’s the time to talk with your doctor about whether you should get screened for prostate cancer, for colorectal cancer, or for both. Screening tests can find cancer early, when treatment works best.

Don’t worry about the cost—if you’re a man 50 or over, Medicare covers a digital rectal exam once every 12 months. Also, Medicare covers a variety of colorectal cancer screenings—like the fecal occult blood test, flexible sigmoidoscopy, or colonoscopy—and you pay nothing for most tests.

Prostate cancer is the most common cancer in men, second only to lung cancer in the number of cancer deaths. Not sure you should get screened? You’re at a higher risk for getting prostate cancer if you’re a man 50 or older, are African-American, or have a father, brother, or son who has had prostate cancer.

Colorectal cancer is also common among men—in fact, it’s the second leading cause of cancer-related deaths in the United States among cancers that affect both men and women. If everyone 50 to 75 got screened regularly, we could avoid as many as 60% of deaths from this cancer.

In most cases, colorectal cancer develops from precancerous polyps (abnormal growths) in the colon or rectum. Fortunately, screening tests can find these polyps, so you can get them removed before they turn into cancer. If you’re 50 or older, or have a personal or family history of colorectal issues, make sure you get screened regularly for colorectal cancer.

June is Men’s Health Month, a perfect time for you (and the men in your life) to take the steps to live a safer, healthier life. Watch our videos on how Medicare has you covered on prostate cancer and colorectal cancer screenings, and visit the Men’s Health Network website on Men’s Health Month for more information.

Filed under: Uncategorized
Source: Medicare