Tag: Medicare

Schedule Your Annual Enrollment Appointment Today To Enroll!

Get ready for a game-changer in managing your healthcare costs! Starting January 1, 2025, Medicare Part D is rolling out an exciting new program under the Inflation Reduction Act. The Medicare Prescription Payment Plan will revolutionize how you pay for your prescription drugs by allowing you to spread out your out-of-pocket costs over the year.

Inflation Reduction Act 2025 Changes:

• $2,000 Yearly Cap: A new $2,000 yearly cap on Medicare prescription drug costs.
• Price Negotiations: Medicare can now negotiate drug prices directly.
• Improved Access and Cost Caps: Improved access to biosimilars and a $35/month cost-sharing cap on insulin in durable medical equipment pumps.

What’s in Store for You:

• Monthly Payment Magic: Say goodbye to unpredictable costs! All Medicare Part D plans will now offer capped monthly payments for prescription drugs, making it easier than ever to budget and manage your healthcare expenses.
• Who’s In?: If you’re enrolled in Medicare Part D, including those receiving Extra Help, you’re eligible to benefit from this groundbreaking payment plan. Those with higher cost-sharing, especially for brand-name or non-preferred drugs, will find this program particularly helpful.
• Opting In Is a Breeze: During the Annual Enrollment Period (AEP) starting in October 2024, you can opt into this program as you enroll or renew your Part D coverage. Already enrolled? No worries! You can jump on board at any time during the plan year by reaching out to your Part D sponsor.

Key Features to Remember:

• Applies to both standalone Medicare prescription drug plans and Medicare Advantage plans with drug coverage.
• This program doesn’t reduce your total prescription drug costs but makes them way more manageable.
• Your Part D sponsor is committed to processing your election requests promptly.
• If you’ve been hit hard with high cost-sharing early in the year, this program could be a game-changer for your budget.

As you prepare for the upcoming changes, it’s important to stay informed and make decisions that align with your healthcare needs and budget. Consider discussing this new payment plan with me during your AEP appointment to see how it fits into your overall healthcare strategy. With the Medicare Prescription Payment Plan, managing your prescription drug costs has never been easier.

REMINDER! Schedule Your Annual Enrollment Period (AEP) Appointment Today!

Don’t wait until the last minute! Schedule your AEP appointment now to get a full coverage review to ensure your 2025 health care needs are in place, and receive assistance in opting into this new prescription payment plan program.

Fill out the 2025 Insurance Updates Form prior to your appointment to streamline the process and make the most of your enrollment period.

To schedule your appointment please contact our office today. We look forward to assisting you with your 2025 healthcare needs!

As we soak up the sun this summer, it’s essential to balance enjoyment with skin protection, especially for seniors who face increased risks of skin cancer. Did you know that UV rays from the sun are the primary cause of skin cancer? But fear not! With practical tips and understanding Medicare coverage, you can stay safe and enjoy sunny days responsibly.

Protecting Your Skin: Practical Tips

1. Seek Shade Strategically During peak sun hours (10 a.m. to 4 p.m.), find shade under an umbrella, sunshade, or in shaded areas to reduce UV exposure. It’s your personal oasis from the summer heat.
2. Fashionable Sun Protection Stay stylish and sun-safe with loose, breathable clothing, a wide-brimmed hat, and UV-blocking sunglasses. Protect yourself from head to toe while looking your best.
3. Sunscreen: Your Skin’s Superhero Always apply broad-spectrum sunscreen with SPF 30 or higher. Reapply every two hours (more frequently if swimming) and opt for waterproof formulas for continuous protection.
4. Embrace Vitamin D Wisely Maintain strong bones with vitamin D-rich foods like salmon and dairy products. Consult your doctor about supplements for additional options beyond sun exposure.
5. Review Your Medications Certain medications can increase skin sensitivity to sunlight. Discuss your prescriptions with your healthcare provider to stay informed and protected.
6. Stay Cool and Hydrated Beat the heat by staying hydrated and wearing lightweight, breathable fabrics. Moisturize regularly to keep your skin healthy and hydrated.

Early Detection Saves Lives

Monitor your skin for changes such as unusual moles or patches. Promptly notify your doctor if you notice anything concerning – early detection is crucial for effective treatment.

Understanding Medicare Coverage for Skin Cancer

The senior population faces significant risks from skin cancer, with over 40% of melanoma cases in the U.S. occurring in those aged 65 and older. Here’s how Medicare supports your skin health:

1. Medicare Part B Coverage
   • Routine skin cancer screenings are not covered for asymptomatic individuals under Medicare Part B.
   • Medicare Part B covers doctor examinations if you notice changes in moles or skin growths. If further evaluation is needed, Medicare may extend coverage for specialist referrals.
2. Coverage for Treatment
   • Medicare Part A and Part B cover outpatient treatments for skin cancer after meeting deductibles. Hospitalization costs are covered under Part A after its deductible is met.
3. Annual Wellness Visits
   • Medicare Part B offers annual wellness visits, providing an opportunity to discuss skin health concerns with your doctor. The visit is covered without applying the Part B deductible.
4. Medicare Advantage and Prescription Coverage
   • Medicare Advantage plans cover the same benefits as Original Medicare (Part A and B) and may offer additional coverage options.
   • Medicare Part D plans cover prescription drugs used for skin cancer treatment, expanding coverage beyond Original Medicare’s limitations.

Whether you’re considering Medicare Advantage or need comprehensive coverage insights, exploring your options ensures you receive the best care for your skin health needs. Stay informed, stay protected, and enjoy the sunshine responsibly this summer!

If you have further questions about your Medicare coverage, or would like to schedule a plan review, please contact our customer support services.

As we journey through life, the health of our brain becomes increasingly important, especially for those of us who are Medicare beneficiaries. June marks Alzheimer’s & Brain Awareness Month, a time dedicated to raising awareness about Alzheimer’s disease, other dementias and emphasizing the importance of brain health. Understanding your Medicare coverage benefits is key to taking proactive steps to support your cognitive well-being.

Understanding Alzheimer’s Disease

Alzheimer’s disease is the most common form of dementia, affecting millions of people worldwide. It is a progressive brain disorder that gradually impairs memory, thinking, and behavior. While aging is a significant risk factor, Alzheimer’s is not a normal part of aging. It affects about one in nine people aged 65 and older, making it a critical issue for the Medicare community.

The Alzheimer’s Association defines three general stages of Alzheimer’s:

Early-stage Alzheimer’s (mild)

Middle-stage Alzheimer’s (moderate)

Late-stage Alzheimer’s (severe)

“Every 65 seconds, someone in the US develops Alzheimer’s.”

Alzheimer’s Association

Early Detection & Brain Health with Medicare Coverage

Early detection of Alzheimer’s can make a significant difference in managing the disease. It’s important to understand what’s included in your Medicare Benefits.

Original Medicare (Part A and Part B) will typically cover the diagnosis, evaluation, treatment, and care planning for Alzheimer’s at every stage. Original Medicare (Part A and Part B) will typically cover the diagnosis, evaluation, treatment, and care planning for Alzheimer’s at every stage.

Medicare Part A will cover:

• Inpatient medications (prescription drugs you may get during an inpatient stay)
• Medicare covers inpatient hospital care and some of the doctors’ fees and other medical items for people living with Alzheimer’s or another dementia who are age 65 or older.
• Home health care can be covered up 35 hours of in-home care per week depending on the circumstances.  To receive this coverage, the patient must be “homebound” and need part-time skilled nursing care.
• Hospice care will be provided under Medicare Part A, with very little in out-of-pocket costs. In most cases, hospice care is provided in a patient’s home.

Medicare Part B provides coverage for a range of essential medical services, including:

• Annual Wellness Visits: Medicare offers a comprehensive annual wellness visit, including cognitive impairment assessments to catch early signs of dementia for timely interventions and better symptom management.
• Part B also covers a separate visit with a doctor or health care provider to fully review your cognitive function, establish or confirm a diagnosis like dementia or Alzheimer’s disease, and develop a care plan.
• Durable medical equipment such as a hospital bed or a wheelchair for in-home use.

Medicare Part A and Part B may also cover different mental health services including inpatient psychiatric are and outpatient services such as counseling and behavioral health specialist care.

If you or a loved one notice memory loss or cognitive changes, don’t hesitate to discuss it with your healthcare provider. Early diagnosis can lead to better treatment options and support services!

Medicare Part D Benefits:

If the person living with dementia has Medicare, then he or she can enroll in Medicare’s Part D prescription drug plan.

Medicare collaborates with insurers and private companies to provide a range of prescription drug plans, each differing in cost and covered medications. During the Medicare Part D annual open enrollment period (October 15th to December 7th), Medicare beneficiaries have the opportunity to enroll in a drug plan. Those already enrolled in a Part D drug plan can also switch to a different plan during this period.

Tips for Choosing Your Part D Plan:

1. Check if the plan covers most or all of the drugs you currently take.
2. Ensure your Alzheimer’s drugs are on the formulary.
3. Confirm the plan covers the doses you need.
4. Review if the plan’s rules restrict coverage of your Alzheimer’s drugs or require prior approval.
5. Check if the plan requires you to try a cheaper drug before covering your current one (step therapy).
6. Look for any quantity limits on pills covered in a given period.
7. Compare all costs, including deductibles, copayments, and coinsurance, not just monthly premiums.
8. Verify if your local pharmacy is in the plan’s network, as mail order may be an option, offer incentives, or be required for prescriptions.

Promoting Brain Wellness Through Healthy Habits

While there is currently no cure for Alzheimer’s, research shows that a healthy lifestyle can help reduce the risk of cognitive decline. Here are some tips to keep your brain healthy:

• Stay Physically Active                          
• Eat a Brain-Healthy Diet
• Stay Socially Engaged
• Keep Your Mind Active
• Get Quality Sleep

Alzheimer’s & Brain Awareness Month is a reminder that while aging is inevitable, we can take steps to protect our brain health. As Medicare beneficiaries, we have access to essential resources and services that can help us maintain cognitive function and quality of life. Let’s embrace this month as an opportunity to educate ourselves, support others, and commit to brain-healthy habits.

Contact us to learn more about your Medicare coverage benefits that can assist you with preventative services to promote your brain and cognitive health.  You can also learn more about what’s included in Medicare Part A and B, and Part D, at Medicare.gov.

Estimated reading time: 5 minutes

Navigating the complex landscape of health savings accounts (HSAs) and Medicare can be challenging. With Imperial Coverage Insurance, we aim to simplify this process for you. As a Medicare planning leader, we strive to provide clear, actionable information. Below, we delve into the relationship between HSAs and Medicare, ensuring you are well-equipped to make informed decisions.

Introduction

Health Savings Accounts (HSAs) offer a tax-advantaged way to save for medical expenses, but their relationship with Medicare is not straightforward. Understanding how these accounts work with Medicare is crucial for anyone planning for healthcare costs in retirement. At Imperial Coverage Insurance, we specialize in helping individuals navigate these complexities.

The Basics of Health Savings Accounts

HSAs are savings accounts that allow individuals to set aside pre-tax dollars for medical expenses. These accounts are typically paired with high-deductible health plans (HDHPs) and offer several tax advantages:

• Contributions are tax-deductible.
• Interest and earnings grow tax-free.
• Withdrawals for qualified medical expenses are tax-free.

However, the rules change once you enroll in Medicare.

Medicare Enrollment and HSA Contributions

Once you enroll in Medicare, you can no longer contribute to an HSA. It’s essential to stop contributions by the first month you’re enrolled in Medicare. Enrolling in Medicare Part A or Part B makes you ineligible to contribute to an HSA, though you can still use the funds already accumulated in your HSA.

Using HSA Funds After Medicare Enrollment

After enrolling in Medicare, you can use your HSA funds to pay for a variety of expenses, including:

• Medicare premiums (Part B, Part D, and Medicare Advantage)
• Medical expenses not covered by Medicare
• Deductibles, copayments, and coinsurance
• Certain long-term care services

When used for qualified medical expenses, these funds remain tax-free, ensuring you continue to benefit from your HSA even after Medicare enrollment.

Timing Your Medicare Enrollment

Strategic timing of your Medicare enrollment can maximize your HSA benefits. If you plan to delay Medicare enrollment because you are still working and covered by an employer’s HDHP, you can continue contributing to your HSA. However, once you stop working or lose employer coverage, you must enroll in Medicare, and contributions to your HSA must cease.

Medicare Part A and HSA Contributions

Medicare Part A (hospital insurance) is often premium-free for those who have worked at least ten years in Medicare-covered employment. Enrolling in Part A when first eligible at age 65 is typically advantageous. However, if you wish to continue contributing to an HSA, you must delay enrolling in Part A.

Employer Contributions to HSAs

If you are still working and covered by an employer’s HDHP, your employer can continue contributing to your HSA. However, if you enroll in any part of Medicare, your and your employer’s contributions must stop. Understanding this dynamic is crucial for effective Medicare planning and maximizing your HSA benefits.

Special Considerations for Those Over 65

Individuals over 65 still working have unique considerations regarding HSAs and Medicare. If you delay Medicare enrollment, you can continue contributing to your HSA, but avoiding any gaps in coverage is crucial. Once you retire or lose employer coverage, timely enrollment in Medicare is essential to avoid penalties and ensure continuous coverage.

Case Study: Maximizing HSA Benefits

Consider John, a 66-year-old still employed with an HDHP. By delaying Medicare enrollment, John continues to contribute to his HSA, enjoying the tax advantages. Upon retirement at 68, John enrolls in Medicare, using his accumulated HSA funds to cover medical expenses, including Medicare premiums. This strategic planning allows John to maximize his healthcare savings and benefits.

Navigating the intersection of HSAs and Medicare requires careful planning and a clear understanding of the rules. At Imperial Coverage Insurance, we are committed to providing you with the guidance and expertise to make informed decisions about your healthcare savings. By understanding the nuances of HSAs and Medicare, you can maximize your benefits and ensure financial security in retirement.

For more personalized advice and Medicare planning, contact Imperial Coverage Insurance today. As Mark Legaspi, our senior advisor, says, “Our mission is to simplify Medicare planning for you, ensuring you make the best decisions for your health and financial well-being.”

Frequently Asked Health Savings Account Questions

During Nursing Home Week

As we observe Nursing Home Week, we want to take a moment to acknowledge the dedicated nurses, caregivers, and staff who provide round-the-clock care to our loved ones. This week serves as a reminder of the commitment to ensuring the well-being and comfort of our elderly population. For seniors and their families, understanding how Medicare intertwines with nursing care is crucial for planning and ensuring access to the necessary services.

Medical Coverage for Nursing Home Care

Nursing homes provide a variety of services and personal care assistance. Medicare coverage for nursing homes, however, varies depending on factors like the specific facility, required services, and duration of stay.

Medicare coverage depends on:

• State and federal laws.
• National coverage decisions made by Medicare.
• Local coverage decisions made by companies.

Medicare Part A Skilled Nursing Facility (SNF) Care:

extends coverage for skilled nursing facility (SNF) care under specific conditions. This encompasses a spectrum of services for a limited time, including the following:

• Hospital inpatient care.
• Skilled nursing facility care.
• Nursing home care.
• Hospice.
• Home health care.

To qualify for Medicare-covered SNF care, a beneficiary must have undergone hospitalization for a minimum of three consecutive days and necessitate skilled care or rehabilitation services that can only be administered within the confines of a skilled nursing facility. 

*Note that a patient must check in to a skilled nursing facility within 30 days of leaving the hospital. On top of that, it must be for the same illness or condition related to the hospital stay.

Duration of Medicare-Covered SNF Care:

• Medicare encompasses coverage for up to 100 days of SNF care per benefit period. Nonetheless, coverage extending beyond 20 days mandates the beneficiary to bear a daily coinsurance amount.
• It’s incumbent upon individuals to familiarize themselves with the criteria governing continued Medicare coverage in an SNF setting, along with the prospective out-of-pocket expenses entailed.

Medicare Advantage Plans (Part C) and Nursing Care:

• Certain beneficiaries may be enrolled in Medicare Advantage (Part C) plans, which are dispensed by private insurance entities sanctioned by Medicare. These plans frequently encompass coverage for skilled nursing care, albeit the specifics may vary.
• Beneficiaries enrolled within Medicare Advantage plans should meticulously scrutinize their plan’s coverage nuances, inclusive of any stipulations or prerequisites concerning nursing care.

Long-Term Care and Medicare:

• It’s imperative to discern that Medicare typically refrains from extending coverage for long-term care in nursing homes for protracted durations. Long-term care requisites, such as assistance with activities of daily living (ADLs) or custodial care, are generally excluded from Medicare coverage.
• Individuals may find themselves compelled to explore alternative avenues, such as long-term care insurance, In-Home Health Care, or Medicaid, to defray the costs associated with prolonged nursing home stays.

In-Home Health Care: A Viable Alternative: In-home health care provides a valuable alternative for individuals requiring assistance with daily activities after a hospital stay.  This option allows individuals to receive care in the comfort of their own homes, maintaining a sense of independence and familiarity. In-home health care services can include:

• Meal planning/preparation
• Assistance with dressing, bathing, toileting
• Light housekeeping
• Accompany to doctor’s visits and other appointments

In-home health care plans are available at various levels and do not have age requirements or underwriting, making them an affordable option for seniors and their families. This option is especially beneficial after a hospital stay when care is needed but does not meet the requirements for nursing facility coverage under Medicare. 

Medicare coverage in nursing homes is a vital resource for elderly and disabled individuals in need of skilled nursing care. While it comes with limitations and eligibility requirements, it serves as a crucial safety net for those who might otherwise struggle to afford necessary care. Knowing and exploring your options to receiving care can greatly impact your quality of life and peace of mind.

If you would like more information and guidance on your Medicare coverage, skilled nursing facility benefits, or in-home health care plans, please don’t hesitate to contact our office today at (631) 476-4015 or email us at mlegaspi@imperial-coverage.com.

Exploring the 3 Ways You May Qualify

Medicare offers Special Enrollment Periods (SEPs) that allow individuals to enroll in or switch Medicare plans outside of the standard enrollment periods. These SEPs are crucial for individuals who experience certain life events or qualify for specific circumstances. Let’s explore what qualifies you for a SEP and how you can take advantage of them.

Qualifying for a Special Enrollment Period

There are three main reasons why you may qualify for a Special Enrollment Period:

1. Qualifying Life Events (QLEs): If you experience a QLE, such as moving to a new area, losing health coverage, or other life-changing events, you may be eligible for a SEP.
2. 5-Star Special Enrollment Period: Medicare rates plans on a scale of 1 to 5 stars, with 5 stars being the highest rating. If a 5-star plan becomes available in your area, you can switch to it during a SEP.
3. Working Past Age 65: If you delayed enrolling in Medicare because you had employer-based coverage, you have an 8-month SEP to enroll in Medicare once that coverage ends.

Qualifying Life Events and Special Enrollment Periods

If you have Medicare and experience a QLE, you may qualify for a SEP to change your Medicare Advantage or Prescription Drug Plan. These events include:

• Changing your primary residence
• Losing your health insurance
• Being eligible for other health insurance

*Each QLE has a specific timeframe within which you must act to qualify for a SEP. For example, if you move, your SEP is typically 60 days after your move.

5-Star Medicare Special Enrollment Period

If a 5-star Medicare plan becomes available in your area, you can switch to it during the 5-star SEP, which runs from December 8 to November 30 of the following year. It’s important to compare plans to ensure the new plan meets your needs.

Enrollment in Medicaid or Extra Help

Most people with Medicare can only make changes to their drug coverage at certain times of the year. If you have Medicaid or receive Extra Help, you may be able to make changes to your coverage one time during each of these periods:

• January – March
• April – June
• July – September

If you lose benefits from Medicaid or Extra Help, you will have a one-time opportunity to adjust your Medicare Advantage enrollment.

Disenrollment from your initial Medicare Advantage plan

If you initially enrolled in a Medicare Advantage plan upon becoming eligible for Medicare, you have a 12-month window to disenroll from the plan and return to Original Medicare.

If you previously dropped a Medicare Supplement Insurance plan to join a Medicare Advantage plan but now want to switch back, you also have a 12-month period to do so (as long as this was your first enrollment in a Medicare Advantage plan).

Working Past Age 65 and the Special Enrollment Period for Medicare Part B

If you or your spouse work past the age of 65 and delay enrolling in Medicare, you have an 8-month SEP to enroll in Medicare Part B once you retire or lose employer coverage. This helps you avoid late penalties.

Avoiding Gaps in Coverage and Part D Late Enrollment Penalties

To avoid gaps in coverage, enroll in Medicare before you lose employer-based coverage. If you anticipate retiring, contact your employer’s human resources department one or two months in advance to time your Medicare enrollment correctly.

Understanding Medicare Special Enrollment Periods is crucial for individuals to make informed decisions about their healthcare coverage. Whether you’re experiencing a QLE, have access to a 5-star plan, or are working past age 65, knowing your options and timing is key to maximizing your Medicare benefits.

If you would like more information on the SEP, or to find out if you may qualify, please contact our office today and we would be happy to assist you.

If you’re new to Medicare, understanding the various enrollment periods can be a bit overwhelming. With the Annual Enrollment Period (AEP) coming to a close, two crucial enrollment periods are just around the corner: the General Enrollment Period (GEP) and the Medicare Advantage Open Enrollment Period (MAOEP).

Both run simultaneously from January 1^st to March 31^st.

First, some background. When you are new to Medicare, you have an Initial Enrollment Period (IEP) that runs for a total of 7 months: 3 months before the month you turn 65, the month you turn 65 and the 3 months following that month.

Example: If your birthday is December 3rd, your IEP starts on September 1st and ends on March 31st.

This is the best time to enroll in Original Medicare (Parts A and B together) because you’ll avoid potential penalty fees and delays in healthcare coverage.

However, if you happen to miss your Initial Enrollment Period (IEP), don’t worry. You get another chance each year during the General Enrollment Period (GEP) to sign up for Medicare Part A and/or Part B. During the GEP, you can only enroll in Medicare Part A and/or Part B.

During this time, you cannot:

• Enroll in a prescription drug plan (Part D)
• Buy a Medicare Advantage plan (Part C)
• Change any existing coverage you might have (like going from one Advantage plan to another or dropping Part D)
• Make any other changes to your coverage

Penalties for Signing Up Late

If you sign up for Parts A and/or B during the General Enrollment Period, you might have to pay extra on your usual premiums – that’s the penalty for signing up late. That’s why it’s a good idea to enroll during your Initial Enrollment Period (IEP).

• Part A Late Enrollment:

If you need to purchase Part A and miss your first Medicare eligibility chance, your monthly premium may increase by 10%. The penalty lasts for twice the number of years you delayed. For example, if you wait 2 years to sign up, you’ll pay a higher premium for 4 years. Special Enrollment Periods may exempt you from penalties – check your eligibility.

• Part B Late Enrollment:

You usually won’t face a Part B penalty with a Special Enrollment Period. Expect an extra 10% for each year you could have enrolled but didn’t. Your income may also affect your premium. Learn more about Special Enrollment Periods for your options here: Special Enrollment Periods | Medicare

During the GEP, there is another period called the Medicare Advantage Open Enrollment Period (MAOEP). The main difference between Medicare Advantage Open Enrollment and General Open Enrollment is who can use each one and what changes you can make.

The Medicare Advantage Open Enrollment Period (MAOEP) lets you:

1. Change Medicare Advantage Plans: You must be already enrolled into a Medicare Advantage plan. If both Medicare Advantage plans are offered in your area, you may change from one to another.
2. Go Back to Original Medicare: You can drop your Medicare Advantage plan and return to Original Medicare (Parts A and B), with a Part D prescription drug plan. You also have the option to add a Medicare Supplement (Medigap) policy. However, this is not a guaranteed issue. You will most likely have to go through Medical Underwriting.

During this time, You cannot:

• Enroll in Medicare Advantage for the first time if you are currently on Part A and Part B (Original Medicare).

Understanding and navigating these enrollment periods is crucial for ensuring that you have the right Medicare coverage. If you have any questions or need more information on changing your plan, feel free to reach out to our office today at  (631) 476-4015 and we would be happy to assist you.

November is a crucial month in the health calendar as it is recognized as Diabetes Awareness Month. This is a time to bring attention to the disease and the millions of people affected by it. It’s also an excellent opportunity for us to shine a light on the importance of health, reminding everyone that your health matters!

1. Type 1 Diabetes: An autoimmune condition where the body’s immune system attacks and destroys the insulin-producing cells in the pancreas. People with type 1 diabetes need lifelong insulin therapy.
2. Type 2 Diabetes: The most common form, often linked to lifestyle factors like poor diet and lack of exercise. It results in the body not using insulin properly or not producing enough, leading to elevated blood sugar levels.
3. Gestational Diabetes: A temporary form that occurs during pregnancy, usually resolved after childbirth, but it increases the risk of developing type 2 diabetes later in life.

Diabetes Management and Medicare: Know the Updates for 2024

One of the most significant challenges for those managing diabetes is the cost of the necessary supplies and medications. However, for Medicare recipients, there will be some important changes starting in 2024 that could make managing diabetes more affordable.

What’s Covered Under Medicare Part B:

• Injectable insulin used with a traditional insulin pump
• Insulin used with a disposable insulin pump
• Diabetes screenings and exams
• Diabetes self-management training (DSMT) – Medicare may cover up to 10 hours of this initial training – 1 hour of individual and 9 hours of group training. You may also qualify for up to 2 hours of follow-up training in each calendar year that falls after the year you got your initial training.
• Therapeutic shoes & inserts covered each calendar year:
• One pair of custom-molded shoes and inserts
• One pair of extra-depth shoes

Medicare will also cover:

– 2 additional pairs of inserts each calendar year for custom-molded shoes

– 3 pairs of inserts each calendar year for extra-depth shoes

In 2024, Medicare Part B will be extending the $35 monthly co-pay for insulin provided through durable medical equipment (DME). This is a significant improvement that will help many people manage their diabetes more effectively. Furthermore, blood sugar testing supplies will also be available with a $35 monthly co-pay, making it easier to monitor and manage diabetes-related complications.

Medicare Part D Coverage

For those using injectable insulin not associated with a traditional insulin pump or insulin used with a disposable pump, Medicare Part D has got you covered. Additionally, Part D covers certain medical supplies required for insulin injections, including syringes, gauze, and alcohol swabs. Insulin that is inhaled is also covered under Part D.

Starting January 2024, Medicare Part D will extend its coverage to include diabetes-related expenses. Under this plan, individuals can benefit from a $35 monthly co-pay for diabetes medications, and this cost won’t be subject to the plan’s deductible. This expansion is a positive step in making diabetes management more accessible and affordable for Medicare beneficiaries.

Medigap Coverage

If you have Part B and Medigap covering your Part B coinsurance, your plan should cover the $35/month (or less) cost for each covered insulin.

Reversal and Prevention- Keep Diabetes in Check!

Type 2 diabetes, which constitutes about 90-95% of all diabetes cases, is often associated with lifestyle factors. According to the International Diabetes Federation, over 50% of type 2 diabetes is preventable.  It’s essential to address preventive measures and potential reversals for individuals with type 2 diabetes or those at risk. For those with type 2 diabetes or at risk, lifestyle changes play a crucial role.

The 3 pillars to battle Diabetes are Weight loss, adopting a balanced diet, increasing physical activity.

The Medicare Annual Enrollment Period (AEP) is a crucial time of year for Medicare recipients to reevaluate their coverage and make necessary changes. This period, which runs from October 15 to December 7 annually, offers the opportunity to find more affordable coverage, reduce prescription drug costs, or even get more coverage for a similar price. To help you make the most of the AEP, we’ve identified three common mistakes to avoid.

1. Ignoring Your Medicare Annual Notice of Change (ANOC)
   The Annual Notice of Change (ANOC) is a vital document sent to Medicare beneficiaries, outlining any upcoming changes in plan coverage, service area, or costs starting in January. Don’t overlook this document; it provides insight into what adjustments you may need to make to your Medicare plan. According to a survey in 2020, 46% of beneficiaries did not review their current plan’s coverage. It is important to take the time to review your ANOC  to help ensure you are properly covered in the upcoming year.
   
2. Not Considering Prescription Drug Coverage (Medicare Part D)
   Even if you don’t currently take prescription medications, signing up for a Medicare Prescription Drug Plan (Part D) is essential to avoid potential late penalties in the future. The only exception is if you have creditable drug coverage from another source.
   
   Don’t forget to compare your plans! Fewer than 2 in 10 Medicare Advantage prescription drug plan (MA-PDs) enrollees (18%) and 3 in 10 stand-alone prescription drug plan (PDPs) enrollees (27%) compared their plan’s drug coverage with drug coverage offered by other plans in their area. To help minimize costs, select a Part D plan with the lowest premium and adjust it as your medication needs change. Alternatively, consider a Medicare Advantage plan with built-in prescription drug coverage for comprehensive benefits.
   
3. Not Being Alert to Medicare Scammers
   Medicare fraud is a sad reality, and beneficiaries need to remain vigilant. Protect your personal information, including your Social Security number, bank account details, and Medicare ID number. Only share this information with authorized individuals and trusted sources. Beware of scammers seeking to exploit your Medicare information.

The Medicare Annual Enrollment Period is a valuable opportunity to optimize your healthcare coverage. By avoiding these common mistakes and staying informed, you can make the most of this period and secure the benefits you deserve. Be proactive in reviewing your options, considering prescription drug coverage, and safeguarding your personal information to ensure a smooth and beneficial AEP experience. 

Contact us today to schedule your Medicare coverage review appointment to ensure the proper benefits are in place for 2024.

September is World Alzheimer’s Month, so we feel it’s vital to equip ourselves, our clients, and community with knowledge about this condition and how Medicare can lend a helping hand.

Whether you’re directly impacted or simply curious, we’re here to provide you with clear, concise information to navigate this journey together.

Understanding Alzheimer’s:

 Alzheimer’s is a progressive brain disorder that affects memory and thinking. It’s common among seniors and can be challenging. But fear not – knowledge is power, and we are here to shed light on what to look for and how to seek help.

Spotting the signs Spotting the Signs:

• Memory loss disrupting daily life
• Challenges in planning or solving problems
• Difficulty completing familiar tasks
• Confusion with time or place
• Trouble understanding visual images or spatial relationships
• New problems with words when speaking or writing
• Misplacing things and losing the ability to retrace steps
• Decreased or poor judgment
• Withdrawal from work or social activities
• Changes in mood and personality
• Confusion with time or place
• Trouble understanding visual images or spatial relationships
• New problems with words when speaking or writing
• Misplacing things and losing the ability to retrace steps
• Decreased or poor judgment

Understanding Your Medicare Coverage and preventative services:

Wondering how Medicare fits into the picture? We’ve got you covered. Discover what cognitive screenings and tests are covered by Part B, and how Part D can assist with certain medications related to cognitive symptoms.

Cognitive Impairment Screening: Medicare Part B provides coverage for cognitive impairment screenings for beneficiaries who exhibit symptoms of cognitive decline or are at risk for cognitive impairment. These screenings can help identify early signs of conditions like Alzheimer’s disease. Your healthcare provider can perform these assessments during your annual wellness visit or at other times when necessary.

Neurological Services: Medicare Part B covers a wide range of neurological services, including consultations and evaluations with neurologists or other specialists. These services are essential for diagnosing and managing conditions affecting brain health.

Alzheimer’s Medications: Medicare Part D, which is the prescription drug coverage portion of Medicare, covers medications used to treat Alzheimer’s disease. Common Alzheimer’s medications, such as cholinesterase inhibitors (e.g., donepezil) and N-methyl-D-aspartate (NMDA) receptor antagonists (e.g., memantine), are often included in Part D formularies. Beneficiaries with Alzheimer’s can enroll in a Part D plan to help cover the costs of these medications.

It’s important to note that specific coverage details can vary depending on your Medicare plan, including whether you have Original Medicare (Part A and Part B) with a separate Part D prescription drug plan or if you have a Medicare Advantage plan (Part C) that may bundle medical and prescription drug coverage. Therefore, it’s crucial to review your plan’s benefits, formulary, and any prior authorization requirements with your Medicare provider or plan administrator to understand the extent of coverage for Alzheimer’s-related services and medications.

Living Well and Planning Ahead:

Living with Alzheimer’s requires adapting to new routines and adjusting. Learn how staying mentally and socially active, maintaining a healthy diet, and engaging in regular exercise can contribute to your well-being. Also, get insights into planning for the future, including legal and financial aspects.

Support for Caregivers:

For caregivers, your role is invaluable. Learn about respite care options covered by Medicare and find out about support groups that can provide guidance and comfort.  Alzheimer’s can have a significant impact on mental health. Medicare covers mental health services, including counseling and therapy, which can be beneficial for individuals with Alzheimer’s and their caregivers.

Local Support Groups: Local Alzheimer’s support groups and community organizations often host informational sessions and provide resources for individuals and caregivers facing Alzheimer’s-related challenges. These groups can offer valuable connections and practical advice.

Join the Movement: World Alzheimer’s Month is a time to raise awareness and show our solidarity. Let’s share information, stories, and encouragement to create a network of understanding and compassion. Together, we can make a difference in the lives of those affected by Alzheimer’s. Stay tuned for more insightful posts throughout this special month. Remember, you’re not alone on this journey – together, we’ll navigate the path ahead.  Please contact us to learn more on preventative care services, and Alzheimer’s medications that may be covered under Medicare Part D.

Two reliable resources related to Alzheimer’s disease and Medicare coverage:

Alzheimer’s Association: Website: www.alz.org This website is a wealth of information on Alzheimer’s disease, offering resources for patients, caregivers, and those interested in learning more. You can find information about symptoms, diagnosis, care options, and support services.

Medicare Official Website: Website: www.medicare.gov The official Medicare website provides comprehensive information about coverage and benefits for Medicare beneficiaries. You can learn about Medicare Part B coverage for cognitive assessments and screenings, as well as Part D coverage for certain medications related to cognitive symptoms. These resources can offer you detailed information and guidance to help you better understand Alzheimer’s disease and how Medicare can support you or your loved ones.

You can also download this helpful guide for more information.