Garrett Ball, President/Owner, Secure Medicare Solutions

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Garrett Ball is the owner/president of Secure Medicare Solutions, Inc. SMS is a national, independent Medicare insurance brokerage that works with 25+ companies in 40+ states. SMS has been in business for 10+ years and worked with thousands of people going on to Medicare or already on Medicare.

As an independent, education-focused agency, our goal is to provide precise, easy-to-understand information about Medicare and Medicare plans, allowing potential clients to evaluate and ask questions on their own terms. Ultimately, this allows Medicare beneficiaries to make a prudent choice that fits their needs.

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About Garrett Ball

"We discovered Garrett Ball online. Over the years he has saved us thousands of dollars in premiums for both Supplemental Part B and Part D drug policies with his cost comparisons and advice. He is uniquely prompt in responding to our e-mail inquiries and very professional in all areas. Highly recommended for all Medicare needs." - Ron T, IN
" I am so happy to review this company and Garrett Ball, the President. He has helped me through the confusing maze of Medicare, Supplements, and Advantage plans and the plans I am on now have been outstanding. Do not hesitate to contact Garrett Ball. You will not be disappointed. Response time is within 24 hrs., and always with thorough information to help his customers. Even when I have not contacted him for many months, he seems to remember and respond like it was yesterday. Great customer service seems to be hard to find these days, that is why I am so impressed with Secure Medicare Solutions. You will truly find a solution to any of your questions or problems." - Sandy W, SC/FL
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New Medicare Cards – What You Need to Know

The new Medicare cards are coming! With the Equifax security breach in the news, as well as other recent hacks of personal and sensitive information, this news could not come soon enough. Medicare will begin mailing out the new Medicare cards in April 2018.

new Medicare cards

FIRST LOOK! The new Medicare cards will no longer contain your Social Security number. Instead, they will have a random, unique sequence of numbers and letters.

Currently, Medicare cards contain a Social Security number on them with a letter at the end. The letter, by the way, indicates whether you are drawing Social Security yet, and whether your Social Security is based on your work history or that of a spouse, former spouse or deceased spouse. Most Medicare cards contain the Social Security number of the insured person.

In 2015, Congress passed a law requiring Medicare to change the way they identify Medicare beneficiaries on their Medicare cards. It’s a bit of an undertaking with Medicare having to assign all Medicare beneficiaries a new unique number and recreate 60 million Medicare cards. The rollout of the new Medicare cards will take place over a 12-18 month period, and it will begin in April 2018.

“We want to make this process as easy as possible for everybody involved,” said Seema Verma, the administrator of the Centers for Medicare & Medicaid Services, on a conference call Thursday.

Medicare has set up a website specific to the transition, will also be sending out handbooks related to this and has a call center to handle questions specific to the new Medicare cards.

So, what do you, as a Medicare beneficiary, need to know about the new Medicare cards:

  1. First and foremost, you should not do anything with your current card until you receive the NEW Medicare card. Keep using the current card, then once you receive the new one, replace the “old” card (the one with a Social Security number on it) with the new card (the one with the unique set of random numbers and letters on it).
  2. Be patient. CMS Head Seema Verma stresses that the rollout will START in April 2018 but it will carry over into 2019. We would expect it will last until late 2019. There has been no indication yet on how they will decide who gets the new cards first or what order they will go in.
  3. The new cards will be paper, just like the current cards (we know, it doesn’t make sense to us either!). $242 million just doesn’t buy you what it used to, I guess.
  4. Do not give anyone your current Medicare card or any information from it. Just like everything else that pertains to seniors, there is certain to be scams related to the new Medicare card rollout. To repeat, Medicare will NOT be asking you for your old Medicare card back or any information from it.
  5. When you receive the new Medicare card, take care to appropriately and effectively destroy the old one. Remember, it has your Social Security number on it. Burning it up may be taking it too far (but it is paper, after all). Whatever you do – cut it, shred it, burn it, flush it – make sure you leave no trace since it has your personal information.
  6. The new Medicare cards do not affect anything about your actual Medicare coverage. Your benefits will stay the same.
  7. If you have a Medicare Advantage plan instead of “original” Medicare, you will still get a new Medicare card (even though you don’t have to actually use it). Make sure you keep it in case your Advantage plan cancels you or you decide to go back to regular Medicare in the future.
  8. If you have a Medicare Supplement (Medigap) plan, you will also receive the new Medicare card but should not need to contact your Medigap company with the new information.

If you have any questions about this transition, or anything else related to Medicare, we are here to help. Feel free to contact us online or call us at 877.506.3378.

Do You Need Supplemental Insurance with Medicare?

What does Medicare cover?

Medicare, administered by The Centers for Medicare & Medicaid Services (CMS), is the largest health insurance program in the U.S. Created as a result of the Social Security Act in 1965, its enrollees account for about 40 million people.  Original Medicare does not pay for everything. Even if you are covered by Medicare Parts A and B, there will be some out-of-pocket expenses you may have to incur, i.e. copayments, coinsurance and deductibles, as well as travel outside the U.S. Original Medicare pays for 80% of your Part B medical expenses; the remaining 20% (of the Medicare-approved amount of the service, if the doctor or other health care provider accepts assignment) is your responsibility. That 20% gap could place a significant financial burden on you, resulting in very high out-of-pocket expenses.  There are no limits to the Part B 20% copays.  That is the reason why it is necessary to have a Medicare supplemental insurance plan in place.  This insurance is commonly referred to as a Medigap policy, its name implying its purpose to fill in the gaps where Medsenior staying healthyicare coverage does not exist.

There is usually no premium to pay for Part A of Medicare upon turning age 65, if you or your spouse paid Medicare taxes while working.  That is why this is often called premium-free Part A.  Important! To qualify for Medicare Part A and/or Part B, you must be a U.S. citizen or be lawfully present in the U.S. (be a legal resident of the U.S. for the last five years).

Part A covers the following:

  • inpatient hospital stays, including a semi-private room, meals, general nursing, drugs as part of your inpatient treatment and other hospital services and supplies.
  • physician’s fees
  • home health care – it covers medically necessary part time or intermittent skilled nursing care and/or physical therapy, speech language pathology services, and the need for continuing occupational therapy.  Your care must be ordered by a physician and it must be provided by a Medicare-certified home health agency
  • skilled nursing facilities,
  • hospice care – to qualify either a hospice doctor or your doctor must certify that you are terminally ill (life expectancy of 6 months or less).  After 6 months, you must be re-certified if you are still there.  Coverage includes pain management modalities, medical, nursing and social services, drugs, certain durable equipment, aide and homemaker services.  Hospice does not cover spiritual or grief counseling; stay in a facility (room & board) unless the hospice medical team deems it necessary for pain and symptom management; and the stay must be in a Medicare-approved facility.
  • critical access hospitals (small rural facilities)
  • inpatient care in a religious nonmedical health care institution.
  • blood – no charge except in cases where the hospital must buy the blood for you.  In that case, you must either pay the hospital for the first three units of blood you receive during the calendar year; or have blood donated by you or someone else.

Part B of Medicare is the medical insurance part.  It covers medically necessary physician’s services, i.e. x-rays, laboratory and diagnostic tests, flu and pneumonia vaccinations, blood transfusions, some ambulance transportation, and chemotherapy. In addition, outpatient care, physical and occupational therapy and some home health are also covered services.

Covered services also include the following:paying for medicare part b

  • Preventive screenings such as bone density tests, breast cancer screenings (mammograms), cardiovascular disease screenings and cervical and vaginal cancer screenings;
  • Clinical research studies
  • Mental health services
  • Surgical second opinions
  • Durable medical equipment (canes, walkers, wheelchairs, etc.), prosthetic and orthotics, surgical dressings, and therapeutic shoes and inserts.

According to the CMS website, coverage is equal to 80 percent of the lower of either the actual charge for the item or the fee schedule amount calculated for the item, less any unmet deductible. The beneficiary is responsible for 20 percent of the lower of either the actual charge for the item or the fee schedule amount calculated for the item, plus any unmet deductible.

What is not covered by Parts A and B of Medicare?

Medicare does not cover the cost of:

  • Routine dental care
  • Eyeglasses
  • Hearing aids and exams for fitting them
  • Acupuncture
  • Cosmetic surgery
  • Any type of custodial care for those who are unable to live independently.  That is provided you do not have an acute illness that would necessitate skilled nursing services.  For example, Medicare would not cover the medical expenses of someone in a nursing home who has Alzheimer’s or dementia, unless they suffered an acute illness, i.e. heart attack or pneumonia.
  • Long-term services
  • Concierge care (retainer-based medicine, boutique medicine, platinum practice or direct care).

In summary, supplemental insurance can help most people enrolled in Medicare pay for the things that are not covered by Medicare.  It covers the “gap” that Medicare Parts A and B do not cover.  The additional expenses can be quite substantial and become a financial burden to seniors.  Although Medigap plans have standardized benefits regulated by the Federal Government, it is very important to note that costs can vary from company to company, even though the insurance and the coverage is the same.  So, choose a plan wisely!

When Is the Medicare Open Enrollment Period?

When is the Medicare Open Enrollment Period?

The Medicare Open Enrollment period is terminology that many people often use to refer to the end of the year period during which you can change medical and prescription plans. However, there is definitely some serious confusion about this period and some misuse of the term. This is, at least in part, due to the enormous amount of marketing the insurance companies do during this time of year. So, let’s clear up the Medicare open enrollment period confusion.medicare open enrollment period

Medicare Open Enrollment: When You First Turn 65 or Start Medicare

The actual Medicare open enrollment period is when you first turn 65 or go on Medicare Part B. During this time period, you have open enrollment into a Medigap (Medicare Supplement) plan. This open enrollment period lasts for 6 months starting with the first day of the month you turn 65 (or your Part B effective date if that date is later). During this time, you cannot be made to answer any health questions or undergo any medical underwriting to be approved on a Medigap plan.

Likewise, when you turn 65 or start on Medicare Part B, you have an initial election period, during which you can select a Part D plan (prescription drug plan) without restriction or penalty. This initial election period lasts for 7 months – the month you turn 65 and three months on either side of that month. During this time, you can select any Part D plan without restriction or penalty.

If you are opting to go with a Medicare Advantage plan, you get the same initial election period as detailed above – 7 months including the month of your 65th birthday and three months on either side of that month.

So, What is the Annual Medicare Enrollment Period?

The period that occurs annually, at the end of each year, is actually the “annual election period” or AEP. This period does not apply at all to Medigap policies (Medicare Supplements). On the contrary, this period only applies to Part D and Part C (Medicare Advantage).medicare annual election period and open enrollment

The annual election period runs from October 15 to December 7. During the AEP, you can make changes to your Part D prescription drug plan or your Part C Medicare Advantage plan. Any changes that you make will take effect at the start of the following calendar year.

Many people often mistakenly think that you can also make unrestricted changes to your Medigap plan during that period; however, that is not the case. While you certainly can compare and change your Medigap plan during that period, you do still have to answer medical questions and be approved. It is not, technically, an open enrollment period for Medigap plans though. And, you can compare Medigap plans and change your plan at any time of the year.

How to Prepare for the Medicare Annual Election Period?

If you have either a Part D plan or a Medicare Advantage plan (Part C), you will receive a notice of plan changes for the following year in the mail. This usually comes in late September or early October. It is crucial not to merely disregard this mailing. Some of these plans change drastically each year, and you don’t want to get stuck in a deteriorating plan.

When you receive your notice of plan changes, you should look over it carefully. It should show a side-by-side comparison with the previous year’s benefits. See what changes have been made and decide, based on the plan changes, your satisfaction with your plan, and any changes to your health or finances, whether you want to “shop” for a new plan.

If you do want to shop for a new Part D or Advantage plan, keep in mind that you can only do so during the annual election period, which runs from October 15 to December 7.

Secure Medicare Solutions is a leading, independent Medicare insurance agency. We work with the companies that do Medicare Supplement plans so that you can compare all options in a centralized, unbiased place. We also provide Medigap quotes online by email and can answer any questions that you have. You can reach us at 877.506.3378 or online.

Should I Pay a Doctor’s Bill If I Think Medicare Should Have Paid?

Have you ever received a bill from a doctor’s office that you thoughtmedicare should have paid was incorrect? Maybe an incorrect amount – or maybe even a bill that you thought that Medicare should have paid and your Medicare Supplement should have paid? This seems to be happening more and more with Medicare beneficiaries, to the point that I hear about another instance of this every week or two from my clients.

Hear are the three steps that I recommend taking if/when this happens to you:

  1. First of all, DO NOT just pay it right away when you get it if you think Medicare should have paid. No matter what the facility says about sending you to collection, damaging your credit, showing up at your door to get the money, etc., if you don’t think you owe it or that something is incorrect, don’t pay it. Many providers rely on third-parties for medical billing, and the reality is that they make mistakes. It can be difficult to recover money paid after the fact, so before you pay it, move on to step 2 and investigate it.
  2. If you get a bill that you think is incorrect, you should pursue investigating it. Did they bill both you and Medicare? Did Medicare pay but they billed you anyway? If one of these things happened, it does not necessarily mean there was something illicit going on, but you should always investigate it. The best/first way to do this, in my experience, has been to call Medicare (1-800-MEDICARE) to find out if they received a bill for the date of service in question. They should be able to very easily look up that date and tell you if they did. If they did, they can also tell you if they paid it, or if they didn’t, why they didn’t pay it. That is a good starting point. From there, you know what to say when you call the doctor’s office.Keep in mind that Medicare Supplement plans (Medigap) pay when Medicare pays and do not pay when Medicare does not pay. So if Medicare did not receive, or did not pay, a bill then your supplement company would never have any received the Medicare crossover request to pay their portion.medicare should have paidAnother tip as you investigate – make sure to record date/time that you called and who you speak with.
  3. After you call Medicare itself and the provider’s office, you should have some answers to what happened or how it can be fixed. Sometimes, it’s as simple as a coding error on the claim. Other times, the provider’s office could have billed you while waiting for Medicare’s payment. Regardless, you should certainly pursue it and not blindly pay a bill that you don’t think is your responsibility.All this said, it’s possible that the bill IS your responsibility. Keep in mind that Medicare does not cover anything it considers experimental or not medically necessary. Also, traditional Medicare does not cover preventive dental or vision.

If this happens to you and you are one of our clients, please call us. While Medicare will not give us information about your claims, due to HIPAA regulations, we can do a three-way phone call or guide you through the steps to finding a solution to the problem.

 

Why Should You Use an Independent Broker to Choose a Medigap Plan

There are several options for comparing and enrolling in a Medigap plan. First, you can contact each company that offers plans in your area to compare plans and rates. Although this is certainly an option, it is one that would be incredibly time-consuming. The alternative is using an independent broker – an independent broker allows you the opportunity to compare multiple options in a centralized place, get unbiased feedback about the various plan options and make an informed choice.

Often, people end up choosing a plan that is higher in price than other options, without understanding the standardization of plans which mandates that all companies offer the same coverage and work the same way. This can lead to paying more for the exact same thing. An independent broker’s job is to help you compare the options to pick a plan that is competitively-priced for the coverage level you want.

If you have questions about this or want to look at the options in your area, please contact us online or call us at 877.506.3378.

Current Trends in Medicare and Medigap Insurance

The only thing that is certain in regards to Medicare and Medigap insurance is change. Each year, deductible amounts, premiums, coverage, etc. all change on both “original” Medicare (Parts A & B), Part D (Rx coverage) and Medigap plans. Add to that the changing marketplace for medical insurance in general, and you have a lot to keep up with.

We’ve put together a rundown of some of the changes/trends we see today, in early 2016, which may be helpful.

  • First of all, the Medicare Part B premium has changed for people who are “aging in” to Medicare in 2016. In most cases, if you already had Part B, you get the benefit of the “hold harmless” provision, which keeps your Part B premiums at the same level as they were in 2015. But for new beneficiaries in 2016, the premium is $121.80/month.
  • The average Part D premiums for 2016 increased to $41.46 (up 13% from 2015 numbers!). Of course, with Part D, you have to look at the whole picture of how a plan covers your medications. But still, this change is significant. Approximately 83% of people are paying more for Part D in 2016 than they did in 2015.
  • There are fewer Part D plans available. Part D options peaked at an average of 55 per state in 2007. Since that time, the number of available options for Part D in each state has steadily declined. Currently, there are an average of 26 plans in each state. Fewer options means less competition.
  • Likewise, there are fewer Medicare Advantage choices. In some areas of the country, they are down to 1-2 companies offering plans. This, coupled with lower reimbursement rates (the Federal government pays these plans) has further reduced the benefits offered by these plans. This is a trend we would expect to continue and possibly expand in the next couple of years.
  • More companies are entering the Medigap marketplace. Last year, in 2015, there were 3-4 large insurance companies that began a foray into the Medicare Supplement market. Some were more successful than others, but overall, this greater level of competition in most areas has led to increased price competition and lower (compared to past years) rate increase percentages.
  • Plans G and N are grabbing a larger portion of the Medigap market share. Plan G rates, in particular, have been more stable than ‘F’ rates in recent years, so although the Part B deductible (which ‘G’ doesn’t cover) has gone up, Plan G continues to attract more customers.
  • More and more Medigap companies are offering a husband-wife discount, and many companies are expanding that to be a household discount, available even if both spouses do not have a plan with the same company.
  • The “donut hole”, or coverage gap, for Medicare Part D continues to reduce in size. As part of the ACA legislation, the Medicare “donut hole” is being reduced each year, leading up to its eventual elimination in 2020.
  • The number of doctors that are accepting Medicare patients has seemed to stabilize, according to a Kaiser Family Foundation study. This may/may not be attributable to the recent “doc fix” legislation, which was passed in April to avoid a proposed 21% cut in doctor reimbursement rates.

If you have questions about any of this information or want to speak with someone directly, you can call us at 877.506.3378 or reach out to us online on our Facebook page or Contact Form.
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Garrett Ball is the owner/president of Secure Medicare Solutions, Inc, a leading, independent Medicare insurance brokerage. We are licensed in 43 states and have helped thousands of Medicare beneficiaries navigate the Medicare maze over the last 8 years.

Medigap Rates Online – Can You Get Them and How?

A common question is whether you can get Medigap rates online. Many people are surprised to learn that it is not as easy as you think it should be. In general, you can get some Medigap rates online; however, you don’t always get complete or accurate information. This article explains why and gives you options for obtaining a Medigap comparison.

First of all, as a preface, while you may not get complete or accurate Medigap rates online, you certainly can easily get a complete, unbiased Medigap comparison by email. As far as getting a listing on a website of all plans available to you, with rates customized to your age, gender, zip code, situation, etc., it’s not that easy.

There are three main factors that make it difficult to get Medigap rates online. First, some companies do not allow their rates to be published online by agents. This greatly inhibits your ability to get an accurate picture of the plans available in your area. Second, some Medigap companies only deal with “captive” agents that only represent/sell plans for that one company. “Captive” agents wouldn’t be able to give you rates for other companies besides their company, while independent brokers wouldn’t have rates for “captive”-agent companies. Lastly, companies have different rates for each zip code and age and are changing rates all the time, making Medigap rates online possibly unreliable/out of date.

So, with the unavailability and unreliability of Medigap rates online, what are the other options? The good news for the Medigap consumer is that you don’t have to have a pushy agent come to your house or spend hours on the phone with companies or insurance agents. The easiest way to get Medigap rates online is via email. You can easily get rates delivered directly to your inbox that are both customized to your age, gender, zip code, situation, as well as accurate, reliable and prompt.

Secure Medicare Solutions can provide that service – Medigap rates by email. The important thing here is to make sure you are requesting the information from an independent broker/agent. This way, you can compare all options in a centralized place. There are likely other companies that will provide similar information as well, but most or all require a phone number and address as well in order to contact you with phone calls, mail, etc. Particularly if you are someone turning 65 or ‘shopping’ for a Medigap plan, the last thing you want to do is give someone ELSE permission to call you endlessly. Getting Medigap rates by email solves that problem – gather the information, read at your leisure, compare plans and make a sound, unbiased decision.

If you have questions about this process or want to speak with someone directly, you can contact us using the form here or by phone at 877.506.3378.

The Future of Medigap Plan F

The future of Medigap Plan F was recently called into question with the recent passage of the “doc fix” bill, H.R. 2 – the Medicare and CHIP Reauthorization Act. The headline-stealer of this legislation was the stabilization of physician payments through the repeal of the sustainable growth rate model for Medicare payments to physicians. However, one of the lesser-known provisions could impact future Medicare beneficiaries who purchase Medigap insurance.

Specifically, the bill sets forth surcharges for Medicare beneficiaries that choose to purchase either Medigap Plan F or Medigap Plan C, the two Medigap plans that cover the Medicare Part B (doctor/outpatient) deductible. This deductible currently stands at $147/year, but it is projected to increase to $185/year in 2020 and $217/year in 2023. The idea is that these surcharges offset the higher “use rate” on Medicare from people that have Medigap Plan F. Although this has not necessarily been proven to be the case, the idea is that Medigap Plan F policyholders have no “skin in the game” since it doesn’t cost them anything to see a doctor.

Now, it is important to note that the bill specifies “future” beneficiaries (starting in 2020) as the ones who would be subject to the surcharges on Plan F and C premiums. So, at least on the surface, current Plan F or C policyholders would not be affected. However, a deeper look may foretell some consequences on existing policyholders.

To explain, the surcharges will likely greatly reduce the number of new policyholders into those two plans. Once it is understood that the choice to enroll in Plan F or Plan C equals surcharges on top of premium charges, many beneficiaries will pick a different plan. Hypothetically, this would cause upward pressure on Medigap Plan F and C rates, as there would be fewer new policyholders on those plans. So, long term, the outlook for price stability on those plans is not as great as it would be on other plans.

To editorialize a little here, the “overuse” of Medicare by people on Plan F has not been proven. And, although it does make sense in a vacuum, people that have Plan G, for example, have very little “skin in the game” either ($147/year). So, there is not that big of a difference. Also, since the Federal Government has very limited oversight over the Medigap plans – they are to supplement the Federal program, Medicare – it is hard to see how they should be involved in deciding how people choose to cover their “gaps” in Medicare.

All said though, the bill has become law and unless something changes between now and 2020, there will likely be a lot fewer people choosing Medigap Plans F and C at that point. We’ll stay on top of this and other developments, moving forward, and keep you apprised on how they may affect current Medicare beneficiaries.

Medicare Cards Will No Longer Use Social Security Numbers

Medicare cards will no longer use Social Security numbers as required medicare cardsby a measure in the big Medicare bill signed by President Obama last week. Since its inception, Medicare has used beneficiaries’ Social Security numbers as a part of the Medicare claim number, which is displayed on the red, white and blue Medicare card.

Medicare has four years to implement this large change for new Medicare beneficiaries that sign up for Medicare. Medicare has four additional years to replace existing Medicare beneficiaries cards with a new randomly-generated Medicare claim number. This means that, according to the new bill, Medicare has eight years to fully implement this change.

This change is a result of the increasing incidence of identity theft and need to provide protection for beneficiaries’ Social Security numbers. Most other health insurance companies and programs have long since abandoned the practice of using Social Security numbers as the identifying marker on ID cards, including Medicare Advantage plans (privatized Medicare plans).

The change will, of course, be very costly to implement, and Congress has provided $320 million over four years to implement. This money will come from Medicare trust funds which are financed with payroll taxes and other beneficiary premiums.

Currently, over 4,500 people a day sign up for Medicare, and it is expected that 18 million more people are expected to qualify for Medicare in the next decade. Many new Medicare beneficiaries have been shocked, in today’s climate of identity theft, to find that their Social Security numbers are prominently displayed on their Medicare cards, so this will be a welcome change.

Secure Medicare Solutions client, Larry Williamson, said of the change, “I think it’s high time Medicare caught up with most other organizations that have ceased using Social Security numbers as ID numbers. Medicare cards are cards that you have to have in your wallet, and using the Social Security number just opens you up for the possibility of theft or abuse.”

The plan right now is for Medicare to begin using randomly-generated Medicare claim numbers, which will still be displayed on beneficiaries’ Medicare cards but will not provide the same vulnerability to hackers and thieves.

Garrett Ball owns Secure Medicare Solutions, which is an independent Medicare insurance agency. If you have questions about this change or want additional information, you can contact us here.

 

Senate Passes Medicare Doc Fix Bill, Sends to President Obama

There is big Medicare-related news out of Washington today, as the Senate passed medicare doc fix
the so-called “Medicare doc fix” bill late last night by a resounding 92-8 majority. This bill was recently labeled as the MICRA – Medicare and CHIP Reauthorization Act. President Obama has already said he will sign the bill when it reaches his desk. So, what exactly does this mean for you, the Medicare beneficiary?

Let’s start from the beginning. First and foremost, this bill is in response to the April 1 expiration of the sustainable growth rate for physician payments. When this expired, a 21% cut went into effect for doctor reimbursement rates for Medicare patients. CMS – the government organization that administers Medicare – announced that it would essentially “hold” claims for 14 days until this bill could be passed and signed. Medicare patients should see no effects from this – or really, even know that it is going on behind the scenes – but it is interesting to know nonetheless.

Even more interesting and important is what is actually in the bill itself. Here is a bullet-point summary of what the bill entails (bolded sections of particular importance to Medigap policyholders):

  • The bill repeals the sustainable growth rate of physician payments that had been in effect since 1997 – this is the so-called Medicare doc fix.
  • It replaces that with a .5% increase for physician payments each year for the next five years.
  • The bill created financial incentives for doctors to bill for quality care (“quality care” not defined at this point but will likely follow recent CMS directives).
  • The bill provides 7.2 million over two years for Community Health Centers.
  • It extends funding for nearly two dozen other programs – including federal abstinence programs and extra payments for rural hospitals.
  • The Children’s Health Insurance Program (CHIP) will receive $5 billion for two years.
  • It increases the Medicare Part B and Part D income-related adjustments for premiums for high-earners.
  • In 2020, it requires Medicare Supplement policyholders to pay for the Medicare Part B deductible (currently $147/year) themselves. This eliminates “first dollar coverage”. And, this also means that the Medicare Supplement plan offerings (Medigap coverage chart) would also have to be revamped at some point to account for these changes. Plans F and C would likely be eliminated for new policyholders starting in 2020. If the past is any indication, current Medigap policyholders will be “grandfathered in” and allowed to keep their plans even if it includes first-dollar coverage. However, at that point (2020) or maybe before, there would likely be a considerable amount of rate pressure on people in first-dollar coverage plans, as there would be no “new” policyholders coming into those plans.
  • The overall cost of the bill is approximately $210 billion, with two-thirds of that being added to the Federal deficit and the remaining $70 billion in cost being split between Medicare recipients and providers.
  • Lastly, a previously scheduled hospital payment increase of 3.2 percent – scheduled for 2018 – will be delayed and spread over 6 years.

So, how will this, particularly the change in Medigap design, impact you? In 2010, the Medigap plans were revamped to include several new plans and remove several duplicate plan designs. When that happened, policyholders that had one of the “old” plans were allowed to keep their plan. It is very likely this would be the case with this plan design change as well; however, that will be something to keep an eye on. Obviously, the 2020 start date of this requirement gives plenty of time – even at Government pace – to revamp the coverage chart and implement the changes.

Also, the “doc fix”, which “permanently” replaces the sustainable growth rate should provide some stability to providers who accept Medicare patients and payments. This elimination of payment amount uncertainty is always, ultimately, a good thing for Medicare recipients. It is expected the President Obama will sign the bill into law within the next couple of days.

Garrett Ball is the owner of Secure Medicare Solutions, an independent Medicare insurance brokerage. If you have any questions about this or want additional information about current Medigap plans, please contact SMS at 877.506.3378 or online.