Tag: Medicare

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.