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Medicare Q&A: Who can I contact to learn more about Medicare enrollment and benefits?

i Oct 1st No Comments by

Call your local SHIP program.  The phone number is listed on your copy of the Medicare and You handbook. In Missouri, call 1-800-390-3330. We refer your call to a trained SHIP counselor in your area who will know the local program(s) you seek. We have 300 counselors statewide to help you.

Medicare Q&A: What do I do if I am enrolled in a non-benchmark Medicare Plan, but found out that I am eligible to enroll into a “Benchmark” plan.

i Oct 1st No Comments by

There are four benchmark plans in 2017 that a beneficiary receiving extra help can enroll.  The premium for the benchmark plan will be zero and there is no deductible.  If a beneficiary, who receives full extra help, enrolls in a non-benchmark plan then the premium will be reduced and the beneficiary will be required to pay that monthly premium.

Also, another important reason to work with a SHIP Counselor, and to have the Counselor enter the current drugs that the Beneficiary takes, is to make certain that all drugs are on the ‘Benchmark’ Plan’s Formulary!  Even though a Beneficiary is eligible and could enroll into a $0 Premium plan, if their drugs are not covered by the Benchmark Plan’s formulary, this could cause a much bigger issue.  The cost of those drugs that are not covered, could end up causing the Beneficiary to pay a great deal of money out of pocket! As a result, a small premium might not be so bad.

Medicare Q&A: What do I do if I am already enrolled in Medicare, but also have employer-sponsored or other third-party insurance plan?

i Oct 1st No Comments by

If a beneficiary, 65 years or older, is enrolled in Medicare while he/she is still working and is also enrolled in their employer sponsored plan, the employer plan will be primary to Medicare, in many cases.  In order for this statement to be true for the employee and/or 65 year old spouse, there has to be 20 or more employees, and the beneficiary must still be actively working.

If the employee (or spouse) is under the age of 65 and is enrolled in Medicare due to a disability, in order for the employer plan to be primary in this situation, there must be 100 or more employees.  If the employer plan IS primary to Medicare, the beneficiary is able to delay Part B, or if already enrolled, could drop Part B, without incurring a penalty.  While the employee is still working, he or she may sign up for Part B at any time.  When the Beneficiary decides to end employment, they will then receive a Special Enrollment Period to enroll (or re-enroll) into Part B.

This Special Enrollment Period will last up to eight months after employment ends, or until the employer insurance ends, whichever comes first.

Medicare Q&A: Who do I contact for information about Long Term Care assistance?

i Oct 1st No Comments by

To obtain the most accurate and helpful information regarding Long Term Care Insurance, start with Missouri Department of Insurance.  The department’s website is http://insurance.mo.gov/consumers/LongTerm.  On this site you will find information such as Frequently Asked Questions, Long Term Care Costs, and a variety of additional links and resources.

Medicare Q&A: What do I do if I enroll in a Medicare plan and later have to make an adjustment because of a major life event?

i Oct 1st No Comments by

Call your local SHIP program.  The phone number is listed on your copy of the Medicare and You handbook.  In Missouri, call 1-800-390-3330. Almost all major life events will have a Special Enrollment Period (SEP). This will let you make the changes you need for Medicare coverage. Call to find out if a Special Enrollment Period can work for you.

Medicare Q&A: What do I do if I need help paying for Medicare Part D Plan premiums, deductibles, and co-pays?

i Oct 1st No Comments by

Medicare has a program called Extra Help to help reduce Part D premiums, deductibles, co-pays, and eliminate the coverage gap.  This program is income & resource based, even if your income & resources are slightly higher than the limits, you are encouraged to apply. There are other programs called State Pharmacy Assistance Programs that vary on a state-by-state basis.

You will need to check with your state to see if this program exists in your area.

You can find more information about this Program on the CLAIM website www.missouriclaim.org or by contacting your states’ State Health Insurance Assistance Program (SHIP). In Missouri the number is 1-800-390-3330

Missouri Rx is another program that can help save money on prescriptions.  Missouri Rx covers 50% of the Medicare Part D “gap” and pays 50% of the Medicare Part D Co-pays.

This is the only assistance program that does not count your resources.

To learn more about this program contact your local State Health Insurance Assistance Program (SHIP), go to our website Missouriclaim.org.

Medicare Q&A: What do I do if I am enrolled in Medicare but not enrolled in a Medicare Part D Plan?

i Oct 1st No Comments by

It is important to sign up for a Medicare Part D Drug plan when you are first eligible. If you do not sign up when first eligible you will most likely have to pay a late penalty.  If you have creditable drug coverage (coverage that is as good as or better than Medicare coverage) you will not have a late penalty. Keep proof if you have this coverage.

There are two ways to receive enroll in Medicare prescription drug coverage or a standalone Part D plan:

  1. Original Medicare (Part A and B is called Original Medicare)
  2. You can get a Medicare Advantage Plan with drug Coverage.  Advantage Plans are HMO’s or PPO’s you get your Part A and B and Drug Coverage through Advantage Plans

For more information or to enroll contact your State Health Insurance Assistance Program (SHIP) for Missouri the number is 1-800-390-3330.

Medicare Q&A: What happens if I miss the enrollment deadline? What do I do?

i Oct 1st No Comments by

Call your local SHIP program.  The phone number is listed on your copy of the Medicare and You handbook. In Missouri, call 1-800-390-3330.  We will evaluate your situation and see if you might qualify for a Special Enrollment Period.  No promises but we will try!

Take steps to combat kidney disease

i Mar 4th No Comments by

 

You have two kidneys. They are bean-shaped and about the size of a fist. They are located in the middle of your back, on the left and right of your spine, just below your rib cage.

The kidneys filter your blood, removing wastes and extra water to make urine. They also help control blood pressure and make hormones that your body needs to stay healthy. When the kidneys are damaged, wastes can build up in the body. Early kidney disease usually has no symptoms, which means you will not feel different. Blood and urine tests are the only way to check for kidney damage or measure kidney function. If you have diabetes, high blood pressure, heart disease, or a family history of kidney failure, you should be tested for kidney disease.

If you have kidney disease, it’s important to take steps to manage it, including making certain lifestyle and diet changes. This may involve changing what you drink.

Click here to learn what you should change what to drink with kidney disease.

Click here to learn about other diet and lifestyle changes for kidney disease.

For related information, see “Kidney Disease: A Silent Problem,” an Age Page from the National Institute on Aging at NIH.


 

The information on Kidney Disease was developed for NIHSeniorHealth by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) at NIH

MAKING HEALTH INSURANCE MAKE SENSE

i Nov 30th No Comments by

Answers to Some of the Most Commonly Asked Questions

Q:    Can you explain what the Medicare Part A and Part B premiums will be in 2016?

 A:   For most beneficiaries, the answer is simple:  they will be the same in 2016 as they were in 2015.  That’s because there will be no Social Security cost-of-living increase in 2016 benefits.  As a result, most people will pay the same premium for Part B, as long as the premium is withheld from their Social Security benefit check. That’s about 70% of all people on Medicare. Also, since 99% of beneficiaries get Part A Medicare coverage without a premium (since they or their spouse have at least 40 calendar quarters of Medicare-covered employment during their lives), that won’t change, either.

Q:  What about people who don’t qualify for the no increase in 2016 in their Medicare Part B Premiums?  How much will they pay?

 A:  Some beneficiaries will not qualify for the rule that keeps their Part B premium unchanged.  These include:  people who do not yet collect Social Security benefits; people who will become  new beneficiaries in 2016;  people who have their Part B premiums paid through a different process, such as Federal retirees; and people who pay an additional premium already, because of their income.  People on both Medicare and Medicaid, whose premiums are paid by their States, are also ineligible for unchanged premiums.  All beneficiaries in those categories will see an increase in their Part B premiums to $121.80 per month (higher for those with income-related surcharges).  These groups together account for about 30% of Medicare’s 52 million beneficiaries.

Q:  Are Medicare Part A and B deductibles going up, too?  Will some people be exempt from those increases?

 A:  The Part A deductible for an inpatient hospital admission is going up from $1,260 in 2015 to $1,288 in 2016.  Co-insurance for stays beyond 60 days, and for stays in a skilled nursing facility following an inpatient admission will also increase, by a modest 2.2% in 2016.

The Part B deductible is increasing from $147 in 2015 to $166 in 2016.  This is the first increase in the Part B deductible in 3 years.  These increases will apply to all beneficiaries; those exempt from premium increases will still be subject to the new deductible and co-pay amounts in 2016.

For more information about 2016 premiums and deductibles, you can go to www.medicare.gov, or call Medicare any time of day or night, at 1-800-MEDICARE [1-800-633-4227].

 

Q:  For those consumers who do not have Medicare, or other health insurance, I hear that it is Open Enrollment again through January 31, through the Health Insurance Marketplace; can you tell me about this?

 A:  Yes, Open Enrollment for 2016 Health Insurance Marketplace coverage at healthcare.gov started November 1, and goes through January 31. If you want coverage to begin January 1, you need to enroll before December 15.

The Health Insurance Marketplace is a way for those without health insurance or those who want to look for a better option to find health care coverage from private health insurance plans that fits their budgets and their needs, and you can’t be turned down because of a pre-existing condition – which before the Affordable Care Act law, you could. The Health Insurance Marketplace is not for those who already have or who are eligible for Medicare.

Financial help is available to make coverage more affordable. About 8 out of 10 people who are eligible for Marketplace coverage qualify for financial assistance to lower the cost of their monthly premiums.  And, for many consumers premium increases from last year will be offset because they receive tax credits to make their coverage more affordable.

If you are already enrolled in a Marketplace plan and your plan is still going to be available in 2016, and you want to keep it then you do not have to do anything. However, it pays to shop. You might find a plan that saves you money or has better coverage or both. Last year, those who switched plans within the same level of coverage from the year before, saved an average of nearly $400 on their annual premiums after tax credits.

It is important too that consumers who already enrolled and who are receiving the Advanced Premium Tax Credits, (help with monthly premiums) or the Cost Sharing Reductions, (help with other out of pocket costs) update their applications with their current household income and household size, from last year so that they do not run the risk of losing this help or having to pay back some of the assistance when they file their income taxes next year.

The Affordable Care Act law says that individuals of all ages, including children, have to have minimum essential health coverage, or qualify for an exemption from it, such as making too little to file income taxes, or pay a penalty when filing his or her federal income tax return, as those without health insurance cause insurance premiums to rise, for those who do have health insurance, when the uninsured utilize the health care system.

Coming up in 2016, the penalty for not having health insurance will be 2.5% of your income or $695 per person, whichever is higher and the bottom line is you still won’t have peace of mind coverage if and when you need health care if you don’t enroll in health insurance.

The Affordable Care Act makes quality health insurance available to millions of people who were previously locked out or priced out of the health insurance market.

Free, confidential expert help is available.

  • Apply by phone. Call 1-800-318-2596, 24 hours a day to enroll over the phone, and get help in up to 150 different languages.
  • Apply in person. Free in person help is also available in your community at localhelp.healthcare.gov
  • Apply online at healthcare.gov or gov
  • You can also, Apply by mail. Complete a paper application and mail it in. You can download the paper application form and instructions from HealthCare.gov