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The Medicare.gov website provides a wealth of information to those that need help understanding the many facets of how Medicare works. On occassion we post helpful information from Medicare’s website. Below you will find two charts – one that provides an overview of Medicare monthly premiums and one that provides the costs of Medicare Part A costs in 2012. Over the next couple of weeks we will share information from the Medicare website regarding Medicare Part B (medical insurance) costs as well as Medicare prescription drug plans (Part D) premiums. We hope you find this information beneficial. To find more useful tools from Medicare, click here to visit their site.

 Note: If you’re in a Medicare Advantage Plan, costs vary by plan and may be either higher or lower than those noted above.  Review the Evidence of Coverage from your plan.

The following information can be found at the Medicare.gov.

If your Medicare card is lost, stolen or damaged, you can ask for a new by visiting the Medicare.gov website.

What is a Medicare Card?

• The Medicare card looks like the red, white and blue card shown here.
• Your Medicare card is your proof that you have Medicare health insurance.
• You can use this application only to request a Medicare card. If you need a Medicaid card, please contact your state Medicaid office.

What You Should Know

• Your Medicare card will arrive in the mail in about 30 days.
• It will be mailed to the address Social Security has on file for you.
• If you need proof that you have Medicare sooner than 30 days, you also can request a letter which you will receive in about 10 days.
• If you need proof immediately for your doctor or for a prescription, visit your nearest Social Security office.
• For security reasons, there is a 30 minute time limit to complete each page. You will be given notice when you are about to time out and can get more time to finish.
• You can read more about Social Security’s Internet policy here.

If You Have Moved

• If you have moved and have not reported this to us, you will need to report this change to us before we can process your request.
• If you have moved and have reported this to us recently, you will need to contact us before we can process your request.

Block access to your personal information

If you want to prevent online and automated telephone access to your personal information, you can block access to your personal information.

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The following information is from ihealthbeat.org:

Federal incentive payments have aided nationwide growth in the use of electronic prescriptions, according to a report from e-prescribing network operator Surescripts, Healthcare IT News reports.

The report — titled “The National Progress Report on E-Prescribing and Interoperable Healthcare” — tracked the status of e-prescribing from 2008 to 2010 (Merrill, Healthcare IT News, 5/12).

Key Findings

The number of new e-prescriptions and replies to pharmacies’ electronic renewal requests increased from 191 million in 2009 to more than 326 million in 2010 — a 72% growth rate — the report found.

The report noted that:

• About 36% of office-based physicians were sending their prescriptions to the pharmacy electronically by the end of 2010, compared with 26% the prior year;
• About 190,000 physicians were e-prescribing at the end of 2010;
• About one in four prescriptions were electronic by the end of 2010;
• The number of prescription histories electronically delivered to prescribers increased to 230 million in 2010 from 81 million in 2009 (Lowes, Medscape, 5/11); and
• E-prescribing rates are highest among cardiologists — at 49% — and family practitioners — at 47% (Healthcare IT News, 5/12).

Explaining the Growth

Surescripts said two federal incentive programs helped push the growth in e-prescribing:

• The 2009 Medicare Improvements for Patients and Providers Act, which gave physicians a 2% Medicare bonus in 2010 for e-prescribing with approved software; and
• The 2009 economic stimulus package, which includes Medicare and Medicaid incentive payments for health care providers who demonstrate meaningful use of certified electronic health records. E-prescribing is one of the meaningful use requirements (Medscape, 5/11).

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The Department of Health and Human Services (HHS) released proposed new rules late last week to help doctors, hospitals, and other health care providers better coordinate care for Medicare patients through Accountable Care Organizations (ACOs). An ACO is a network of doctors and other health care providers and suppliers that shares responsibility for providing care to patients.

The latest release from the HHS states that,

ACOs create incentives for health care providers to work together to treat an individual patient across care settings – including doctor’s offices, hospitals, and long-term care facilities. The Medicare Shared Savings Program will reward ACOs that lower health care costs while meeting performance standards on quality of care and putting patients first.  Patient and provider participation in an ACO is purely voluntary.

You or someone you know, may have a serious illness and have more than one doctor and taking more than one medication. If so, you have more than likely witnessed how disorganized your doctor’s office is when it comes to your medical information. No one likes to have to repeat the same information at each visit or watching doctors fumble through unsystematic files. It shows just how much our health care system needs to form accurate coordination of information and better communication between health care providers.

Medicare beneficiaries who have five or more chronic conditions suffer the most – and more than have of the Medicare beneficiaries fall into this category. With such serious conditions as diabetes, heart disease and kidney disease, these beneficiaries are very likely to have multiple physicians. These patients are at risk when doctors have failed to coordinate information in their files – so each physician is not sure what the last doctor did or they may not know which medication or dosage was prescribed. This can inevitably lead to the patient not getting the right care they need and there is an increased risk of being prescribed a medication that should not be taken with a medication prescribed by another doctor. It can also lead to complications that require hospitalization – which could have  easily been prevented. A study was conducted on nearly 12 million Medicare beneficiaries which showed that 1 in 5 patients discharged from the hospital was readmitted within 30 days which means if hospitals and doctors were better organized and coordinated with files and communication ”across care settings” , readmission may have been avoided. (continue reading…)

The following information is from Medicare.gov and it covers what Medicare Part D (Medicare Prescription Drug Coverage) is and it provides valuable resources that may answer questions that you have about this complex topic.

Medicare prescription drug coverage is insurance run by an insurance company or other private company approved by Medicare. There are two ways to get Medicare prescription drug coverage:

1. Medicare Prescription Drug Plans. These plans (sometimes called “PDPs”) add drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private Fee-for-Service (PFFS) Plans, and Medicare Medical Savings Account (MSA) Plans.
2. Medicare Advantage Plans (like an HMO or PPO) are other Medicare health plans that offer Medicare prescription drug coverage. You get all of your Part A and Part B coverage, and prescription drug coverage (Part D), through these plans. Medicare Advantage Plans with prescription drug coverage are sometimes called “MA-PDs.”

If you decide not to join a Medicare drug plan when you’re first eligible, and you don’t have other credible prescription drug coverage, you will likely pay a late enrollment penalty.

How Much Does Medicare Prescription Drug Coverage Cost?

Each plan can vary in cost and drugs covered. The Medicare Drug Plan Finder can help you find and compare plans in your area.

Your Part D monthly premium could be higher based on your income. This includes Part D coverage you get from a Medicare Prescription Drug Plan, or a Medicare Advantage Plan or Medicare Cost Plan that includes Medicare prescription drug coverage. If your modified adjusted gross income as reported on your IRS tax return from 2 years ago (the most recent tax return information provided to Social Security by the IRS) is above a certain amount, you will pay a higher monthly premium.  For more information, visit Social Security’s website.

Many people qualify to get Extra Help paying their Medicare prescription drug costs but don’t know it. Most who qualify and join a Medicare drug plan will get 95% of their costs covered. Don’t miss out on a chance to save. Extra Help and other programs (like Medicare Savings Programs) may help make your health care and prescription drug costs more affordable. (continue reading…)

Banyan Administrators have been providing us with beneficial information about several different aspects of the Health Care Reform and how it affects us. Over the next months and years, employers will be faced with numerous changes, many of which require regulatory clarification. Banyan will continue to keep us up to date and on target with decisions that affect our plans.  Over the past few weeks, Banyan has provided answers to many questions regarding Medicare and how the reform affects you. If you missed the first two articles in this series, make sure to check them out – Article #1 and Article #2. We are sure you will find the information valuable.

The following information is provided by Banyan Administrators:

Arguably the greatest volume of reforms through the Patient Protection and Affordable Care Act (“Affordable Care Act”) signed into law on 03/23/2010 involve Medicare. Some of the provisions are direct reforms to Medicare while other provisions of the Affordable Care Act may have an indirect, but intentional, impact on the program. The following Q&A will give you an overview of the reforms to the Medicare program and how they are all intended to work together.

1.  What are the Medicare Part D reforms?

The first Medicare Part D reform is the closing of the “donut hole”. For Medicare Part D enrollees in 2010, coverage breakdowns as follows: 

• $2,830 – After the enrollee pays the first $310 in drug costs (the deductible), the plan pays 75% of the drug cost up to $2,830 with the enrollee paying the other 25%, then
• $2,831-$4,550 – The “donut hole” – The enrollee pays 100% of their drug costs up to $4,550, then
• $4,551+ – “catastrophic coverage” – The enrollee pays a $2.40 copay for generic drugs. For other drugs the enrollee pays either $6.00 or 5% of the drug cost, whichever is greater.

Beginning in 2010, the reforms going into effect to address the donut hole are: 

• 2010 – Enrollees in the “donut hole” received $250 rebate checks from Medicare
• 2011 – If an enrollee reaches the donut hole, they will be given a 50% discount on the total cost of the brand name drugs while in the gap. Medicare also will phase in additional discounts on the cost of both brand name and generic drugs.
• By 2020 – Effectively close the donut hole so that the plan pays 75% of the drug cost with the enrollee paying the remaining 25%.

The second Medicare Part D reform is the elimination of the Medicare Part D Subsidy paid to employers who sponsor a retiree drug plan.  (continue reading…)

Banyan Administrators have been providing us with beneficial information about several different aspects of the Health Care Reform and how it affects us. Over the next months and years, employers will be faced with numerous changes, many of which require regulatory clarification. Banyan will continue to keep us up to date and on target with decisions that affect our plans.  Over the next few weeks, Banyan will be providing answers to many questions regarding Medicare and how the reform will affect you. We are sure you will find the information valuable.

If you missed the first article in this series that was posted last week, click here.

The following information is provided by Banyan Administrators:

Arguably the greatest volume of reforms through the Patient Protection and Affordable Care Act (“Affordable Care Act”) signed into law on 03/23/2010 involve Medicare. Some of the provisions are direct reforms to Medicare while other provisions of the Affordable Care Act may have an indirect, but intentional, impact on the program. The following Q&A will give you an overview of the reforms to the Medicare program and how they are all intended to work together.

1.  What is the future of Medicare?

What could not have been foreseen in 1965 when Medicare was created was that the United States was coming to the end of the post-World War II “Baby Boom”. More “Baby Boomers” are reaching Medicare eligibility than are being replaced in the work force by younger workers.  With Medicare being funded by FICA taxes, at some point, it mathematically becomes impossible to fund all the benefits for all the Medicare enrollees. (continue reading…)

Banyan Administrators have been providing us with beneficial information about several different aspects of the Health Care Reform and how it affects us. Over the next months and years, employers will be faced with numerous changes, many of which require regulatory clarification. Banyan will continue to keep us up to date and on target with decisions that affect our plans.  Over the next few weeks, Banyan will be providing answers to many questions regarding Medicare and how the reform will affect you. We are sure you will find the information valuable.

The following information is provided by Banyan Administrators:

Health Care Reform – Medicare

What You Need to Know Now About: Medicare

Arguably the greatest volume of reforms through the Patient Protection and Affordable Care Act (“Affordable Care Act”) signed into law on 03/23/2010 involve Medicare. Some of the provisions are direct reforms to Medicare while other provisions of the Affordable Care Act may have an indirect, but intentional, impact on the program. The following Q&A will give you an overview of the reforms to the Medicare program and how they are all intended to work together.

1.  What is the history of Medicare?

As early as 1945, President Harry S. Truman proposed a government administered national social insurance program. It was not until the Social Security Act of 1965 signed into law by President Lyndon B. Johnson that the Medicare program was created. The first senior enrolled into the Medicare program was former President Harry S. Truman. Former First Lady Bess Truman was the second senior enrolled.

The first two programs created in 1965 were Medicare Part A and Medicare Part B. Since that time, Medicare Part C (1997) and Medicare Part D (2006) have been added.

Medicare Part A is hospitalization insurance providing coverage to the Medicare enrollee for inpatient hospital stays. Medicare Part A also pays for other facility-based skilled services such as care at a skilled nursing facility, but, on a limited basis. Most Medicare enrollees do not pay a premium for Medicare Part A coverage because they (or a spouse) have paid enough into the program through payroll taxes prior to retirement. Medicare enrollees do have to meet a Medicare Part A deductible before any benefits are paid. In 2010, the Medicare Part A deductible is $1,100 for an inpatient stay up to 60 days.

Medicare Part B is medical insurance providing coverage to the Medicare enrollee for outpatient services provided by a physician. Services include physician services, nursing services, x-ray, laboratory and diagnostic tests, vaccinations, renal dialysis, outpatient hospital procedures, etc. No benefit is provided for prescription drugs unless the drug is administered by a physician. Participation in Medicare Part B is voluntary if an eligible retiree wishes to participate; the premium amount will be deducted from his social security benefit. In 2010, Medicare Part B monthly premium, on average, is $100.50. The Medicare Part Benrollee also has to meet a $155 deductible and then pay 20% coinsurance.

In 2008, there were 45 million enrollees in Medicare making it the nation’s largest single health care payer in the nation. By 2030, it is expected that enrollment will reach 78 million. In 2008, Medicare spending reached $599 billion which was 20% of the total federal government spending. At $599 billion, Medicare is only surpassed by Social Security and defense spending. (continue reading…)

The following information is from Medicare.gov and is beneficial to those who are new to Medicare. This article will guide them through the actions they need to take in order to get the most from their Medicare benefits. 

New to Medicare? 6 Things You Need to Do

Use this checklist to get the most from your Medicare benefits and make sure your claims get paid quickly and correctly.

1. Fill out an Initial Enrollment Questionnaire
The Initial Enrollment Questionnaire (IEQ) should come in the mail about 3 months before you qualify for Medicare. It asks about other health insurance you have that might pay before Medicare does, like group coverage you have from your employer or through a family member, treatments covered under liability insurance, or workers’ compensation you get.

You must fill out and return this questionnaire to make sure your medical bills get paid correctly and on time. You can:
• Mail back the paper copy you got in the mail.
• Complete the questionnaire online at MyMedicare.gov
• Complete the questionnaire over the phone by calling the Coordination of Benefits Contractor at 1-800-999-1118. TTY users should call 1-800-318-8782.

2. Fill out an Authorization Form
Medicare can’t give personal health information about you to anyone unless you give permission in writing first. If you want your loved ones to be able to get information about your care, it’s a good idea to provide authorization in advance. You can do this in several ways:

• Fill out and submit an e-Authorization Form online: Medicare Online Forms.
• Download and complete a .PDF version of the Standard Authorization form: Medicare Online Forms. Mail the completed, signed form to Medicare BCC, Written Authorization Department, P.O. Box 1270, Lawrence, KS 66044.
• Call 1-800-MEDICARE (1-800-633-4227) and ask for the Standard Authorization form to complete and mail in. Or, the CSR can help you complete the form over the phone, then mail the form to you to sign and return. (continue reading…)

The following information is from Healthcare.gov:

How the Affordable Care Act will make Medicare stronger into the future

• The life of the Medicare Trust fund will be extended to at least 2029, a 12-year extension as a result of reducing waste, fraud and abuse, and slowing cost growth in Medicare. This will provide you with future cost savings on your premiums and coinsurance.
• Medicare will take strong action to reduce payment errors, waste, fraud, and abuse in Medicare. The President has made a commitment to reduce Medicare fraud 50 percent by 2012. The Affordable Care Act makes an historic, ten-year, $350 million investment to prevent, detect and fight fraud in Medicare, Medicaid and the Children’s Health Insurance Program—including criminal efforts to exploit the new law. Visit Stop Medicare Fraud for more information.
• In 2011, if you hit the prescription drug donut hole, you will get a 50% discount on brand-name drugs. Every year after, you will pay less for your prescription drugs in the donut hole until there’s complete coverage of the donut hole in 2020. Between now and then, you will get continuous Medicare coverage for your prescription drugs.
• The coordination of care between doctors and the overall quality of care will improve so that you will be less likely to experience preventable and harmful re-admissions to the hospital for the same condition.
• Hospitals will have new, strong incentives to improve your quality of care.
• Starting in 2014, the Affordable Care Act offers additional protections for Medicare Advantage Plan members by taking strong steps that limit the amount these plans spend on administrative costs, insurance company profits, and things other than health care.

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The following information is from the United States Department of Labor’s web site. Since this COBRA article (or booklet, as the article refers to it) from dol.gov has an abundance of information, we will break the article up into sections over the next few weeks. We hope that you find the information valuable.

An Employee’s Guide to Health Benefits Under COBRA – The Consolidated Omnibus Budget Reconciliation Act

Note: This publication contains information about the COBRA premium reduction provisions of the American Recovery and Reinvestment Act of 2009 (ARRA). This publication has not been updated for recent amendments made to ARRA. For updated information on ARRA and its amendments, please see the COBRA Premium Reduction Fact Sheet.

Premium Reduction Following Involuntary Termination

If you involuntarily lost your job at any time from September 1, 2008 through February 28, 2010, you and/or each member of your family may be eligible for a COBRA premium reduction under the American Recovery and Reinvestment Act of 2009 (ARRA), as amended by the Department of Defense Appropriations Act, 2010 (2010 DOD Act). For individuals who are eligible, it is a 65 percent reduction in COBRA premiums for periods of coverage beginning on or after February 17, 2009. The premium reduction for an individual ends after 15 months of the reduction, upon eligibility for other group coverage (or Medicare), or when the maximum period for COBRA coverage ends, whichever occurs first. Individuals paying reduced COBRA premiums must inform their plans if they become eligible for coverage under another group health plan or Medicare.

You and/or each member of your family are eligible for the premium reduction if:

• You have a qualifying event for continuation coverage under COBRA or a State law that provides comparable continuation coverage (for example, so-called “mini-COBRA” laws) that is the employee’s involuntary termination at any point from September 1, 2008 through February 28, 2010; and
• You elect the COBRA coverage timely.

You are not eligible for the premium reduction if you are eligible for other group health coverage (such as a spouse’s plan) or Medicare. (continue reading…)

Approximately 3 months before your 65th birthday you will receive a letter from Banyan Administrators, LLC outlining your options. ProtectPlus is not a Medicare supplement and in most cases we do not recommend maintaining your ProtectPlus coverage once you are eligible for Medicare. However, factors that may affect your decision include: the size of your firm, whether or not you have a younger spouse and/or dependent children and when you plan to retire. You may contact Banyan Administrators, LLC  at 877-480-7923 to discuss your options.

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The following information is from Medicare.gov.

If you are under age 65 and disabled, and have been entitled to disability benefits under Social Security or the Railroad Retirement Board for 24 months, you will be automatically entitled to Medicare Part A and Part B beginning the 25th month of disability benefit entitlement. You do not need to do anything to enroll in Medicare. Your Medicare card will be mailed to you about 3 months before your Medicare entitlement date.

You may refuse Part B coverage. However, if you decide to pick up Part B coverage at a later date, but before you turn 65, you may have to pay a 10% surcharge in addition to the Part B premium. Also, please be aware that you will automatically be re-enrolled in Part B when you turn 65, even if you previously refused Part B coverage. You may again refuse coverage, but if you keep it you will not have to pay a surcharge.

Note: A Special Enrollment Period is available if you waited to enroll in Medicare Part B because you or your spouse was working AND had group health coverage through a current employer or union. If this applies, you can sign up for Medicare Part B:

• While you are still covered by an employer or union group health plan, through your or your spouse’s employment, or
• During the 8 months following the month when the employer or union group health plan coverage ends or when the employment ends (whichever comes first).

The Social Security Office can answer questions about applying or appealing Social Security Disability benefits. They can also answer questions about when you will be eligible to receive Medicare.

Your 24-month waiting period will be waived if you have been diagnosed with ALS (Amyotrophic Lateral Sclerosis). This disease is commonly known as Lou Gehrig’s Disease.

Home Health Agencies are home health care providers which are licensed according to state and local laws to provide skilled nursing and other services on a visiting basis in your home, and recognized as home health providers under Medicare and/or accredited by a recognized accrediting agency such as the Joint Commission on the Accreditation of Healthcare Organizations.