Posted by Allen Heffler Medicare on 10/29/2014
Medicare’s Annual Enrollment Period is here! From October 15 through December 7, people on Medicare can take advantage of this important enrollment period to review and possibly make changes to their Medicare Insurance in Philadelphia. Changes will be effective January 1, 2015. It is during this time period that those on a Part D prescription plan can make changes. You will want to go onto www.Medicare.gov and see if there is a better Part D plan for you. Every Part D plan changes yearly. Premium, co-pays and plan formularies change. You can go onto Medicare’s website, input your exact prescriptions, dosage and frequency, and the website will rank the Part D plans for you. It is a great tool! During the Annual Enrollment Period, you are also able to get into a Medicare Advantage plan, or change your Medicare Advantage Plan. These plans change yearly-premiums, co-pays, plan designs- so it is important to make sure that you are still in the correct plan. New plans are also being added, so you want to do some homework to see if a new plan makes sense for you. Or perhaps your existing plan is not working well for you- maybe your doctor is no longer in the network. Now is the time to do a review and make changes if needed. Medicare Advantage plans in Philadelphia and the suburbs offer very low premiums, but these plans have co-pays. All of this may seem overwhelming. Allen Heffler, President at MyMedicareAdvisor is here to help! Want an unbiased, free review of your coverage? Just call (215) 658-1776 and we will assist you every step of the way.
Author: admin
Allen Heffler- 2015 Medicare Premiums and Deductible Announced
Allen Heffler Posted on 10/13/2014
Good News! Seniors living in the Philadelphia area, and throughout the country will not see any increase in their Medicare Part B premium for 2015. The surcharge for Medicare Part B premium for higher income people also remains unchanged. There is also no change in the annual Medicare Part B deductible- this remains at $147. Allen Heffler at MyMedicarAdvisor welcomed this recent release from CMS: “This is great news for seniors! For the third year in a row, there will be no increase in the Medicare Part B premium. It will remain at $104.90 per month. There has been a welcomed slowdown to Medicare spending over the past few years, which can be attributed to a number of factors, including a younger, healthier Medicare population-the baby boomers. Since the vast majority of our Medicare clients on a fixed income, this will leave more of their Social Security increase and more income in their pockets.” Allen Heffler is President of MyMedicareAdvisor in Philadelphia, PA. Allen can be reached at (215) 658-1776.
Medicare’s Annual Enrollment Period Approaches- WSJ
Posted by Allen Heffler on 09/21/2014
Wall Street Journal article concerning Medicare
Got Medicare? Two recent developments may help you figure out what type of coverage to elect during this fall’s open-enrollment period, and how to navigate the backlogged system for appealing Medicare claim denials.
Oct. 15 marks the start of Medicare’s seven-week annual election period, when current beneficiaries can add, drop or switch prescription-drug plans and make other coverage changes.
In Medicare, individuals must choose one of two paths: original fee-for-service Medicare, or a federally subsidized Medicare Advantage plan, which typically operates like a health-maintenance or preferred-provider organization. Many who opt for traditional Medicare also purchase a private “Medigap” policy, as well as a separate prescription-drug policy, to patch holes in their coverage.
In recent years, Medicare Advantage plans have gained in popularity, in part because, when compared with a Medigap policy, they generally cover a wider array of benefits, often including prescription drugs and dental care. Many also charge lower premiums, but require members to use the plan’s network of providers.
The Affordable Care Act has sparked fears that Medicare Advantage plans, which cover about 30% of Medicare beneficiaries, will raise premiums, reduce benefits and pare their networks of doctors and hospitals. The reason: Under the law, Medicare will reduce payments to Medicare Advantage plans by some $156 billion by 2022, to bring per-person payments in line with those of traditional Medicare.
Citing the ACA, the nation’s largest Medicare Advantage insurer, UnitedHealth Group,UNH +0.19% has in the past year cut an estimated 10% to 15% of the doctors and hospitals from its nationwide network. Consumer advocates say the insurer targeted providers with the sickest and most expensive patients, leaving patients in the middle of treatments in the lurch. The company says the changes enable it to better coordinate care and that it is “extending continuity-of-care exceptions to members in active treatment.”
Because some of the cuts occurred at times of the year when patients are unable to switch plans, Sen. Sherrod Brown (D., Ohio) and Rep. Rosa DeLauro (D., Conn.) recently introduced legislation that would bar insurers from dropping providers outside of Medicare’s annual open-enrollment period.
Because Medicare Advantage can change annually, it’s important to examine your options during open enrollment, from Oct. 15 to Dec. 7, says Stacy Sanders, federal policy director at the nonprofit Medicare Rights Center in Washington, D.C. Ms. Sanders recommends calling your providers to make sure they still participate in your plan—and using the “Plan Finder” tool at medicare.gov to compare premiums, copayments and deductibles for Part D prescription-drug plans in your area.
During open enrollment, you can switch to either a Medicare Advantage plan or to traditional Medicare, which allows you to see any doctor who takes Medicare. From Jan. 1 to Feb. 14, Medicare Advantage participants may switch to traditional Medicare.
Medicare beneficiaries whose claims are denied should also know that, despite rising backlogs in Medicare’s appeals system, two recent lawsuits indicate that those who press their cases have a good chance of success. The procedure differs depending on whether you’re in traditional Medicare, a Medicare Advantage plan or a Part D prescription-drug plan. Typically, each appeal can be heard five times, the last time in a federal court.
Since 2010, success rates in the first two rounds of appeals of denied claims for home health-care coverage have plunged to 5% or less, according to a class-action lawsuit the nonprofit Center for Medicare Advocacy in Willimantic, Conn., filed on June 4 in the U.S. District Court in Connecticut against the Department of Health and Human Services, which oversees the agency that administers Medicare.
The center’s director of litigation, Gill Deford, says consumers who want a “meaningful review of their Medicare claims” should continue to the third round of appeal—before an administrative law judge—where odds of success jump to 40% or more.
The average wait for a decision from an administrative law judge is 398 days, up from 95 days in 2009, according to HHS. In a federal lawsuit filed Aug. 26, also in Connecticut, the Center for Medicare Advocacy seeks to force the government to take steps so that appeals can be decided within the 90 days the Medicare statute requires. A spokesman for the Centers for Medicare and Medicaid Services, which administers Medicare, says it does not comment on active court cases.
When appealing, ask your doctor for a letter explaining why you need the treatment in question. Those who go before an administrative law judge may benefit from retaining a medical or legal advocate, says Judith Stein, director of the Center for Medicare Advocacy. Most State Health Insurance Assistance Programs (Shiptalk.org) provide free counseling.
By ANNE TERGESEN
Allen Heffler -Philadelphia Medicare Advantage Plans More Expensive, but may be worth It
Posted by Allen Heffler on 08/18/20114
Medicare Advantage Is More Expensive, but It May Be Worth It
Article in New York Times (Aug 18, 2014)
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Medicare Advantage Plans —Part C of Medicare, are private plans offered through insurance carriers, that serve as alternatives to the traditional, public program for those that qualify for it — underperform traditional Medicare in one respect: They cost 6 percent more. But they outperform traditional Medicare in another way: They offer higher quality.
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