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.

 

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.

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.

Last Chance – Medicare Advantage Disenrollment Period (MADP)

Medicare Advantage Disenrollment PeriodThe Medicare Advantage Disenrollment Period is the last chance for those in a Medicare Advantage plan to get out of their plan. This period runs from January 1 through February 14 of each year. During this time period, you can get out of a Medicare advantage plan and return to original Medicare. If you do not take any action of February 14, you are locked into your Medicare advantage plan for the remainder of the calendar year.

If you have a Medicare advantage plan that includes prescription drug coverage, you can also pick up a stand-alone part D plan upon returning to original Medicare. In addition, at the same time, during this Medicare Advantage Disenrollment Period, you can also add a Medigap/Medicare supplement plan at the same time.

This can be an important time for those who are in a Medicare Advantage plan and did not realize the changes that their plan was making for 2015. It is also useful for those who have ongoing medical concerns that may make being in a more comprehensive plan advantageous. Lastly, it can be useful for someone who’s doctor either no longer takes Medicare advantage plans or does not take your particular plan. It is, in essence, a last chance to get out of your current plan for this year.

Medicare advantage plans do change each year. So, it is important to stay apprised of those changes and how they may affect you. Medigap/Medicare supplement plans do not change coverage-wise on a year by year basis. Additionally, these plans do not have networks and are, in general, more flexible across state lines.

To view the coverage chart that shows what Medigap plans cover, you can see it here.

To get more information on the Medicare Advantage Disenrollment Period, or find out whether it makes sense for you to make changes during it, you can contact us at 877. 506. 3378 or via email.

Medicare Annual Election Period is Almost Here

We are approaching the annual election period for Medicare plans. This period runs from October 15-December 7 this year. Plan changes made during this period will take effect on 1/1/15 and will be in place for the following calendar year of 2015.

Contrary to popular misconception, this period has nothing to do with Medicare Supplement (Medigap) plans. It only applies to Medicare Part D and Medicare replacement plans like Medicare Advantage. If you have a Medigap plan, you do not have to do anything to renew your plan – it will continue automatically and is “guaranteed renewable”. This type of plan does not change annually like Medicare Advantage plans do.

However, if you do have a Medigap plan, it may be a good time to review your coverage to ensure that you have the plan that is most advantageous to you. Medigap plans are Federally-standardized, so every company provides the exact same coverage plans. It is highly likely, if you have had your plan for more than a year or two, that you are paying above market price for your Medigap premium. If you want to reevaluate your plan and compare it to what is available in your zip code, you can contact us here to get a comparison via email.

If you are on a Medigap plan with prescription drug coverage (Part D), it is also a good idea to reevaluate your Part D plan. Part D is offered on an annual contract, so these plans do change each year. Sometimes, the changes can be very significant. Also, many times, your prescription medication needs change, so it is a good idea to stay apprised of the options on Part D on an annual or bi-annual basis.

You can do this Part D comparison on Medicare’s website at http://medicare.gov. If you are one of our clients, please contact me directly as we provide this comparison as a free service for you.

If you have questions about this Medicare annual election period, please feel free to contact us at 877.506.3378 or online at Secure Medicare Solutions.

Medicare and Medigap Trends – Five Things to Keep Your Eye On

going on medicareLike many things, insurance is always changing. This has been particularly true over the last few years, and we believe it will continue to be the case into the future. As such, it’s a good idea to keep an eye on some trends that affect Medicare and Medigap insurance. We’ve listed five Medigap trends here that are pertinent for people on Medicare.

  1. Doctor acceptance of new Medicare patients. Some people have been concerned about this for years, and we have heard reports of doctors not seeing Medicare patients in certain geographic areas. Overall, I don’t think this will become a prohibitive problem. But nevertheless, if it occurs in large numbers, it could create quite a “bottleneck” effect for Medicare patients at doctor’s offices that do accept Medicare patients.
  2. Reduction in number of choices in Medicare Advantage plans. This is a trend that is certainly already under way. In many counties, there were 20/30 + plan choices in past years. Those numbers have been greatly reduced, and there are now some counties that have just a couple of companies offering plans. This is due, at least in part, to government regulations that have made it more difficult to make money in and participate in this market. Overall, I think its clear that lack of competition will be a bad thing for the overall appearance of these plans.
  3. Growth of “newer” Medigap plans – a move away from Plan F. This, too, is a Medigap trend that has already begun in earnest. Plan F, which is the most comprehensive Medigap plan, still has the majority of the market share in Medigap plans. However, with the onset of the 2010 re-standardization of plans, there are new offerings, some of which may appeal to different people and have a lower premium. One of the plans that appears to have caught on the most is Plan N, which is a lower level of coverage that still offers comprehensive Part A coverage but does have some out of pocket costs under Part B charges.
  4. The Online Movement. Because you’re reading this online, we’ll assume this comes as no surprise to you. As the next generation of “age-ins” turns 65, the likelihood will continue to increase that they are computer-savvy and more and more comparing and shopping for Medigap and Medicare plans will be done online. Companies will continue to endeavor to meet this demand by making more and more information available online. This and other Medigap trends will certainly have an impact on how companies “market” to the new generation of turning-65ers.
  5. New Medigap Companies Entering the Marketplace. We have seen several companies that are new to the Medicare market enter the fray over the last couple of years, trying to capture the large influx of Baby Boomers aging into Medicare. This includes companies like CIGNA, AFLAC and others, who have either begun or expanded their Medicare plan offerings recently. This will likely continue, with companies that have not offered Medigap plans beginning to do so.

Overall, it is a good idea to stay apprised of any changes to Medicare and Medigap insurance. Certainly, all of them will not affect you, and some may not come to fruition, but being aware of them allows you to be prepared if or when they do.

As always, if you have any questions or want to discuss further, you can contact us at 877.506.3378 or online.

2010 Medicare Changes – New Deductibles, Premium Increases Affect Everyone on Medicare

The Center for Medicare & Medicaid (CMS) recently announced the 2010 Medicare changes, which will have some affect on all Medicare beneficiaries. Despite the fact that there is no cost-of-living adjustment for Social Security for 2010 (for the first time in 20+ years), there are some significant changes to Medicare deductibles, plan premiums, etc that you should be familiar with.

  1. New Medicare Deductibles
    This is the area that affects the largest number of Medicare beneficiaries. The Medicare Part A deductible is increasing from $1060 (2009) to $1100 (2010), and the Medicare Part B deductible is increasing from $135 (2009) to $155 (2010). For those that have Medigap policies, which cover these deductibles, you will not have increased out of pocket costs at the doctor or hospital, obviously. However, if you do not have a Medigap plan to fill in these Medicare deductibles, you will pay these higher amounts beginning in January 2010.
  2. Part B premium increase
    In many cases, the Medicare Part B premium is NOT increasing for 2010. If you currently are paying the standard Part B premium (in most cases, deducted from your SSI check) of $96.40, your premium will likely stay the same.
    However, if you are new Medicare Part B enrollee (as of 1/1/2010) OR if you have an income over $85,000 (individual) or $170,000 (married couple), you will likely pay a higher amount. For those new to Medicare Part B, the new standard premium is $110.50, which is a 15% increase from the 2009 Part B premium.
  3. Changes to Medicare Supplement plans
    The Medicare Supplement (Medigap) changes do not actually take effect until June 1, 2010; however, when they do, they will provide some new options and mark the end to some old options. Some plans, such as Plan J, will not be available to NEW applicants, whereas two new plans, M and N, will begin (Medicare Supplement Plans M and N). For a full outline of the new standardized plan chart, visit Medicare Supplements chart.
  4. Changes to Medicare Part C (Medicare Advantage plans)
    As you have probably already seen, if you are on a Medicare Advantage plan currently, the MA plans have changed a good bit for 2010. In most cases, premiums have gone up and there have been some reduction in benefits with some plans. Additionally, some of the major players in the MA marketplace have pulled out of the MA market. This is plan-specific and does not apply to all plans, but it makes it more important than ever to know what you have and know what else is available in your county.
  5. Changes to Medicare Part D
    The Medicare Part D premiums have changed, in nearly all cases, for 2010. In doing so, the plan that was good for you in 2009, may not be as good for you in 2010. Again, this is plan-specific, and the only way to get an accurate picture of how this affects you individually is to do an analysis of your current plan against other options.

Overall, the changes to Medicare for 2010 will be disconcerting to some, causing an increase in out of pocket costs. However, for those with a Medigap plan and who stay on top of their Part D coverage to ensure they have the best possible plan for their unique situation, the impact of these changes can be minimized.

For a full analysis of options available to you, visit Medicare Insurance Quotes.